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Biomedical subjects

G DeJong

Publications and source records attributed to G DeJong.

At least 37 records · Page 2Linked to original sources
PubMed1992

Use of functional status measures for payment of medical rehabilitation services.

In the search for an appropriate payment system for medical rehabilitation hospitals and units, the use of a functional status measure (FSM) has emerged as a recurring theme. Conceptually, functional status measurement is important because the primary goal of medical rehabilitation is to enhance patient function and independence. Studies indicate that functional status and functional gain are among the best predictors of resource utilization at rehabilitation facilities. This article examines conceptually the use of FSMs in payment for medical rehabilitation in two different types of payment systems--as a means of classifying patients for purposes of determining the applicable payment amount (ie, a "classification system"), and as a means of justifying that payment, or continued payment, for services is appropriate (ie, a "justification system"). Several payment models using an FSM are described and analyzed. An agenda for future research is proposed.

Centers for Medicare and Medicaid Services, U.S.↗
PubMed1991

Toward a health services research capacity in spinal cord injury.

Health services research (HSR) is the research field that seeks to examine systematically the organisation, provision, and financing of health care services. There currently is only a rudimentary HSR capacity in the area of spinal cord injury (SCI). To a large extent, the HSR community has not addressed issues concerning persons with SCI, and the disability research and medical rehabilitation communities have not considered issues of HSR that affect the SCI population. However, due to recent changes in (1) the clinical management of SCI; (2) the expectations of persons with SCI, and (3) health care delivery and finance, the time is now ripe for the development of a HSR capacity in SCI. This article summarises current efforts at HSR in SCI in the United States, which have been primarily in the areas of trauma care and medical rehabilitation. It considers an agenda for future health services research in SCI, which must include research on post-rehabilitation health care and personal assistance needs. Finally, this article suggests strategies for developing a comprehensive HSR capacity in SCI.

Health Services Research↗
PubMed1991

Toward a national personal assistance program: the independent living model of long-term care for persons with disabilities.

Long-term care for people with disabilities in this country traditionally has been provided through family members and friends. Federal and state policy has focused primarily on financing professional health care services provided through nursing homes and home health agencies. An alternative to these models of long-term care is the "independent living model," which is based on the provision of services by nonprofessional personal assistants in the disabled person's home. We describe the model and consider why it is not the dominant approach to long-term care in the United States. We go on to assess options for developing a national personal assistance services program based on the independent living framework, discussing how covered services should be defined, how the program should be financed, whether the program should use means testing, how eligibility and level of benefits should be determined, and what role government should play in implementing the program. Several legislative approaches to developing a national program are explored.

Activities of Daily Living↗
PubMed1991

The health insurance coverage of working-age persons with physical disabilities.

In this article, we examine the health insurance status of working-age, physically disabled persons, and particularly the question of whether the public sector insures a disproportionate share of the highest-risk disabled population. We use descriptive statistics to develop an insurance profile of respondents with severe physical disabilities, and multivariate procedures to model differences between privately and publicly insured, disabled persons. Results of logistic regression procedures indicate that respondents with private insurance alone are more likely to have a high functional level, a positive perception of their health, and to be married, than are those with public (or a combination of public and private) insurance. Specific type of disability, age, and wheelchair use were also found to predict the type of insurance, their effects largely mediated by employment status and income.

Adult↗
PubMed1990

Characteristics of cost outliers who did not benefit from stroke rehabilitation.

The purpose of this paper is twofold: 1) to identify stroke patients who generated substantial charges during inpatient rehabilitation, but did not seem to benefit from that experience and 2) to identify factors that can predict which patients will fall into this group using only variables known at admission to rehabilitation. High cost stroke patients during inpatient medical rehabilitation are examined to determine how they differ from low cost patients and to identify a subset who did not appear to benefit from rehabilitation. This paper is based on longitudinal charge data involving 73 former stroke rehabilitation patients discharged from three Boston area rehabilitation facilities in 1984. Medical charges are presented on initial acute and rehabilitation inpatient stays and on care received in the 12 months after discharge. Among these 73 stroke patients, charges for inpatient medical rehabilitation amounted to nearly 1.8 million dollars, excluding physician fees and out-of-pocket expenses. Of this total, 57.6% was accured by only 33% of the patients. Fourteen patients, who were both rehabilitation cost outliers and apparent rehabilitation "failures," were identified. Rehabilitation charges for these 14 amounted to $673,232 or 37.5% of the total rehabilitation charges for all 73 patients.

Adult↗
PubMed1990

Primary health care needs of persons with physical disabilities: what are the research and service priorities?

The three-stage Delphi method was used to build consensus among experts in primary care and disability on research and service priorities in the area of primary health care for persons with physical disabilities. The specific areas of focus were (1) the high rate of rehospitalization, (2) health issues associated with aging, (3) problems of access to primary care, and (4) innovative organizational approaches to financing and providing primary care services. Issues concerning personal attendant/home health care were ranked highly in all four areas and were especially dominant in the area of rehospitalization. The issue of coordinated health care management received high ratings as well, especially in the "access" area. Other prominent issues included the effects of insurance coverage and the training of primary care providers in disability-related primary care. There was a high degree of correlation between the rankings of physicians and nonphysicians, especially in the areas of hospitalization, aging, and access. This paper examines directions in which future research and service efforts should be focused.

Aging↗
PubMed1989

America's neglected health minority: working-age persons with disabilities.

Debates on health policy at the national level often overlook categorically the 19 million working-age persons with disabilities. Although this heterogeneous population with significantly diverse health statuses has higher than average rates of health care utilization, it remains questionable whether the demographic subgroup sufficiently receives needed types of care. As such, particular targeted solutions in health services delivery are warranted to meet the special requirements of working-age disabled persons. At the same time, access to mainstream health care financing is crucial for a population already excluded frequently from private health insurance coverage.

Adult↗
PubMed1988

Long-term utilization and charges among post-rehabilitation stroke patients.

This paper presents longitudinal charge data on 89 former stroke rehabilitation patients discharged from three Boston area rehabilitation facilities. Medical charges are presented on initial acute and rehabilitation inpatient stays and on care received in the 12 months after discharge. In the sample of 89 stroke patients, charges exceeded four million dollars excluding physician fees and out-of-pocket expenses. Of this total, 23% was for acute hospital care preceding rehabilitation (mean = 18 days), 52% for inpatient rehabilitation (mean = 55 days), 13% for rehospitalizations in the 12 months after discharge from rehabilitation (mean = 22 days) and 12% for a variety of outpatient services.

Adult↗
PubMed1988

Predicting long-term outcome among post-rehabilitation stroke patients.

This paper examines correlates of long-term outcome in a sample of 89 stroke patients discharged from medical rehabilitation. Patients in this study were recruited in 1984 and followed prospectively for a 12-month period postdischarge. This analysis builds on previous studies which have called researchers to move beyond single-outcome studies which use only bivariate analysis. Multivariate techniques are used to evaluate the influence of a number of predictor variables on three measures of long-term outcome: 1) a composite variable that includes functional status, mortality and discharge disposition (home v nursing home); 2) life satisfaction; and 3) medical charges. The results show that 1) multivariate analyses present a different picture from that obtained when using bivariate analysis; and 2) the same predictor variables are not equally important in predicting different outcome variables. From 30-42% of the variance in the three dependent variables is explained by severity of illness, function at admission, age, wheelchair use and in- and out-of-house social supports.

Cerebrovascular Disorders↗
PubMed1988

Total charges for inpatient medical rehabilitation.

Descriptive information on inpatient charges for a sample of 151 individuals discharged from three Boston area medical rehabilitation facilities is presented in this article. The total charges for inpatient rehabilitation were nearly $3 million, and the mean charge was $19,568. Also presented are a description of how charges vary by medical, demographic, social, and external factors and an identification of predictors of total charges for inpatient medical rehabilitation. These results establish a reference point for developing prospective payment systems for inpatient medical rehabilitation.

Analysis of Variance↗
PubMed1988

Prospective payment for medical rehabilitation: the DHHS report to Congress.

Since 1983, when Congress established the Medicare DRG-based Prospective Payment System (PPS) for inpatient hospital care, rehabilitation hospitals and units that qualify under federal regulations have been exempted from the system. Congress recognized that the DRGs were not designed to consider the specific circumstances of rehabilitation patients. It required the Secretary of the Department of Health and Human Services (DHHS) to report on the feasibility of developing a PPS for rehabilitation (and other excluded) hospitals and units. In October 1987, DHHS released its long-awaited report to Congress on "Developing a Prospective Payment System for Excluded Hospitals." The Report concludes that further research is necessary before DHHS can develop specific legislative and regulatory recommendations. Yet, the report also indicates DHHS' desire ultimately to implement a capitation-based PPS for rehabilitation. Until this goal is achieved, DHHS would like to develop a transitional PPS for rehabilitation. However, given that studies indicate that DRGs are an inappropriate basis for a rehabilitation PPS, and measures that would provide a better basis (eg, functional status or capitation) have not yet been fully developed for purposes of rehabilitation payment, it is uncertain how DHHS will achieve these goals in the short run. Until further studies are conducted, development of a transitional system appears ill-advised. Congress and DHHS should, therefore, continue to exempt rehabilitation hospitals and units until an appropriate payment system for rehabilitation can be developed.

Capitation Fee↗
PubMed1987

Life satisfaction and quality of life among disabled elderly adults.

This paper investigates predictors of life satisfaction and quality of life among severely disabled elderly adults. Markides and Martin's (1979) path analysis model was adapted specifically to elderly persons with severe disabilities. The study group comprised 97 patients discharged from three medical rehabilitation facilities in metropolitan Boston during 1984. The adapted model explained about 40% of the variance in quality of life among both men and women, with functional capacity being the most important predictor.

Aged↗
PubMed1987

Predicting charges for inpatient medical rehabilitation using severity, DRG, age, and function.

We examined the effectiveness of using diagnosis related groups (DRGs), Severity of Illness Index (SII), age and function at admission to predict inpatient charges for medical rehabilitation. Data from our sample of 199 indicate that DRGs alone explained approximately 12 per cent of the variation in charges for inpatient rehabilitation while SII explained 26 per cent of the variation. SII, DRG, and age together yielded the highest regression coefficient, accounting for nearly 39 per cent of the variation in total charges; SII and age accounted for 36 per cent of the variation. Within DRG categories, SII was the only important predictor of inpatient charges accounting for 23 per cent of the variation in charges among stroke patients (DRG 014) and 28 per cent of the variation in charges among hip fracture patients (DRG 210). Function at admission was not a useful predictor of inpatient rehabilitation charges within DRGs. These results suggest that SII and age may be useful in developing a DRG-based prospective payment system for inpatient medical rehabilitation.

Activities of Daily Living↗
PubMed1986

Program evaluation of physical medicine and rehabilitation departments using self-report Barthel.

The Barthel Index measures performance of personal care (feeding, dressing, hygiene) and mobility (transferring, walking/wheeling) activities. Since its inception, several revisions of this index have increased its accuracy in measuring functional ability of patients during medical rehabilitation. However, this activities of daily living (ADL) scale is rarely used to determine the abilities of individuals after discharge, leaving assessment of functional outcome incomplete. In this study this index has been converted to a self-report format, which can be completed easily by the patient or family member both during the rehabilitation stay and after discharge. The reliability of the self-report version is examined, by comparing the assessments of patients to those made by the health professionals. A sample of persons at an inpatient rehabilitation facility, who could both read and write, completed the self-report during the week before discharge. Results comparing the assessment of professionals and patients showed a statistically significant difference with p less than 0.001. This paper will suggest reasons for the difference and explore the possibility of using this self-report version as a means to evaluate both the short-and long-term outcomes of rehabilitation programs.

Activities of Daily Living↗