Research will decide resources for rehab

Sampling of hospitals and units will participate

The staff-time studies on the prospective payment system for rehabilitation involve a classic resource allocation model to study what resources are being used by patients in rehabilitation hospitals and units, says Robert E. Burke, PhD, vice president at Washington, DC-based Muse & Associates and principal investigator for the Health Care Financing Administration’s (HCFA’s) patient classification system project.

A Technical Experts Panel is scheduled to meet this month to give input on the work plan, sampling frame, and data collection procedures for the research study by an Aspen Systems/Muse & Associates team, which has the contract from HCFA to develop the patient classification system. Aspen Systems is located in Rockville, MD. Muse & Associates is in Washington, DC.

After the research methodology is in place, the researchers will go on location to a selected number of rehab hospitals and units to do the staff-time measurement studies. The studies will be done at facilities for one week at a time.

"There are approximately 200 rehab hospitals and 800 rehab units within the hospital. We want to make sure our sample reflects what is out there," Burke says.

Facilities will be selected because they meet the sampling frame, Burke says. The team plans to select a representative sampling of providers including facilities of all sizes and those that take patients at all levels of acuity.

During the staff-time measurement studies, the researchers will collect data on patient characteristics and patient-specific resources. They will analyze the data, using the Resource Utilization Groups (RUGS) methodology to determine which patient characteristics are the best indicators of facility resource use. The RUGS system uses patient characteristics such as functional status, need for medical services, cognitive deficits, and behavioral problems to predict resource use.

Hand-held computers

Each clinician at the study sites will use a hand-held personal computer to record the time they spend treating patients.

Using these data, the researchers will determine how much staff time was spent on each patient. For instance, one patient might have received 45 minutes of occupational therapy, an hour of nursing, and 22 minutes of speech.

The researchers will use the Minimum Data Set-Post Acute Care (MDS-PAC) tool, scheduled to be finished on Feb. 1, to assess each patient. These data will be used to come up with a classification system to accurately reflect the level of acuity, or needs of the resident.

"We expect to be able to look at the results of the MDS-PAC and determine a classification model for patients," Burke says.

The researchers will look at how much staff time it takes to treat the various patient classifications to determine the amount of resources used by each classification.

The Aspen/Muse researchers anticipate collecting data in the field, starting in February and ending in June 1999. The goal for completing their analysis is April 2000.