Exploring inpatient rehabilitation data and information with CIHI s National Rehabilitation Reporting System Ian Joiner Manager, Rehabilitation and Mental Health 1
Key points for this presentation > Not-for-profit Canadian Institute for Health Information > Inpatient rehabilitation services data and indicators > Participating facilities in 9 of 10 Canadian provinces > Broad data set, with FIM instrument at the core > More transparency with facility-identifiable reporting > Exploring opportunities for international comparisons > Ongoing refinement of data set, indicators, and reports > Emerging opportunities for other rehabilitation settings and broader cross-continuum analyses 2
Enabled by a pan-canadian not-for-profit organization mandate > Coordinate, develop, maintain and disseminate health information in Canada > Provide accurate and timely information for Sound health policy Effective management of the health system Public awareness: factors affecting good health 3
Situating rehabilitation services information along a continuum > Inpatient acute care units > Ambulatory hospital services Services in the NRS > Inpatient hospital general rehabilitation units > Inpatient specialty freestanding rehabilitation hospitals > Inpatient hospital continuing care units > Long term care facility settings > Community-based ambulatory clinics > Home-based services 4
Available rehabilitation information varies by setting > Inpatient acute care units > Ambulatory hospital services Existing CIHI data holdings > Inpatient hospital general rehabilitation units > Inpatient specialty freestanding rehabilitation hospitals > Inpatient hospital continuing care units > Long term care facility settings > Community-based ambulatory clinics > Home-based services 5
Available rehabilitation information varies by setting > Inpatient acute care units > Ambulatory hospital services > Inpatient hospital general rehabilitation units > Inpatient specialty freestanding rehabilitation hospitals > Inpatient hospital continuing care units Data sets vary by setting needs and preferences > Long term care facility settings > Community-based ambulatory clinics > Home-based services Linkable by unique personal identifiers 6
What is CIHI s National Rehabilitation Reporting System (NRS)? 7
Supporting inpatient rehabilitation information for over ten years > Pan-Canadian, consensus-based approach > Indicators, then data set, then reporting system > National Rehabilitation Reporting System (NRS): Data collection and reporting since 2001-2002 Similar to the CMS IRF-PAI in the United States Three assessments per inpatient episode Wide range of administrative and clinical data elements FIM instrument at the core Additional cognitive and participation measures > Guided by National Rehabilitation Advisory Committee The 18-item FIM instrument is the property of the Uniform Data System for Medical Rehabilitation, a division of U B Foundation Activities, Inc. 8
Voluntary and mandated participation Full Participation Some Participation * FY 2010-2011 G=1 S=0 A=1 G=2 S=5 A=20 G=4 S=7 A=17 G=1 S=1 A=4 G=2 S=5 A=14 G=54 S=14 A=68 G=1 S=0 A=1 G=General S=Specialty A=Appropriate to Participate G=0 S=2 A=6 G=2 S=0 A=4 9
Number of Facilities 120 Plateau in number of facilities 100 80 76 80 85 92 93 99 99 101 101 60 40 20 26 38 0 Fiscal Year Source : NRS, CIHI 2010-2011 10
Number of Submissions Consistency in assessment volumes 40000 35000 30000 25000 # of admission records # of discharge records 20000 15000 10000 26 38 76 80 85 92 93 99 99 101 101 # of facilities 5000 0 Fiscal Year Source : NRS, CIHI 2010-2011 11
What do NRS data say about inpatient rehabilitation in Canada? 12
Number of Clients Clients enter and leave rehabilitation with varying levels of function: Canada 1800 1600 1400 1200 1000 800 600 400 200 0 18 24 30 36 42 48 54 60 66 72 78 84 90 96 102 108 114 120 126 Total Function Score Admission (N=36,189) Mean=82.1 Median=84 Discharge (N=34,364) Mean=103.4 Median=110 Source : NRS, CIHI 2010-2011 13
Number of Clients Clients functional status in rehabilitation is different than seen in the United States 12000 10000 8000 6000 4000 2000 0 18 24 30 36 42 48 54 60 66 72 78 84 90 96 102 108 114 120 126 Total FIM Score Admission FIM Total N = 426,351 Mean = 60.7 Median = 62 Discharge FIM Total N = 426,351 Mean = 87.9 Median = 93 Source: UDSMR Apr 2010 Mar 2011 14
% Clients Most Canadian rehabilitation episodes are less than a month in duration 8 7 6 Specialty Facility (Median LOS=29) General Facility (Median LOS=17) 5 4 3 2 1 0 0 7 14 21 28 35 42 49 56 63 70 77 84 91 98 Length of Stay (days) Source : NRS, CIHI 2010-2011 15
% of Clients While length of inpatient rehabilitation episodes are even shorter in the US 9 8 7 6 Acute Unit (Median LOS = 12) Freestanding Facilities (Median LOS = 13) 5 4 3 2 1 0 1 8 15 22 29 36 43 50 57 64 71 78 85 92 99 Length of Stay (Days) Source: UDSMR April 2010 March 2011 16
Characteristics of inpatient stroke rehabilitation clients: Canadian and American similarities Canada* America** Patients, N 37,435 634,105 Age, yrs <45 45-64 65-74 75+ 70.0 (13.4) 4.6% 25.7% 26.0% 43.7% 70.5 (13.7) 4.5% 25.3% 24.8% 45.4% Gender Men Women Living situation With others Alone 53.7% 46.3% 72.6% 27.4% 47.4% 52.6% 71.1% 28.4% Sources: *National Rehabilitation Reporting System (NRS), CIHI, 2000-2009 **Granger et al., Am. J. Phys. Med. Rehabil., Vol.88, No.12, December 2009 17
Differences in inpatient stroke rehabilitation: Canada and the United States Canada* America** Arrive later Onset to admission, days 23.9 (30.6) 11.5 (21.4) Length of stay, days 40.6 Stay (29.3) longer 17.7 (11.1) FIM total admission More 76.1 functional (24.2) 58.3 (20.0) FIM total discharge 97.8 (23.7) 82.2 (24.2) More functional FIM total change 21.7 Less (16.5) change 23.9 (14.8) Lower efficiency Efficiency, change/day 0.8 (1.0) 1.7 (1.6) Sources: *National Rehabilitation Reporting System (NRS), CIHI, 2000-2009 **Granger et al., Am. J. Phys. Med. Rehabil., Vol.88, No.12, December 2009 18
% of Clients Little functional improvement means more likely discharged to residential care 30 25 Home (N=2657) Residential Care (N=2512) 20 15 10 5 0 0 1-9 10-19 20-29 30-39 40-49 50+ Total Function Score Change Source: NRS, CIHI 2010-2011 19
LOS median Variations in length of stay exist between Rehabilitation Client Groups (RCGs) 50 40 30 20 Orthopedic All RCGs Stroke Spinal Cord Injury 10 0 2005-2006 2006-2007 2007-2008 2008-2009 2009-2010 2010-2011 Discharge Fiscal Year Source : NRS, CIHI 2010-2011 20
Example of using NRS data to guide practice Severity Service Intensity RPG Mild Outpatient 1 Hour/Therapy 2 5 Times/Week 1160 1150 Moderate Inpatient 1 Hour/Therapy 5 Times/Week 1140 1130 1120 1 Hour/Therapy Severe Inpatient 5 Times/Week (Based on Tolerance) 1110 1100 21
Data support more complex methodologies 22
How has reporting of inpatient rehabilitation information become more transparent? 23
Increasing transparency in Canadian inpatient rehabilitation reporting Early 2000 s: 2004: 2005: Paper reports sent by courier Included two aggregate peer groups (General or Specialty) Transition from paper to secure, web-based.pdf reports Same two aggregate peer groups Sharing of facility characteristics (e.g. client mix, volumes) Mid 2000 s Aggregate indicators on public website: QuickStats Same two aggregate peer groups 24
Publicly-available rehabilitation Quick Stats 25
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From July 2009: Secure, interactive web-based reporting > New interactive NRS ereports Microstrategy; data elements as stratification variables Facility names, aggregate values available to all facilities 27
From February 2011: Rehabilitation data with other levels of care > NRS data in the CIHI Portal in February 2011 Microstrategy; ad hoc analytical functionality Facility names; rehabilitation AND acute inpatient data 28
What does the future hold for rehabilitation services information at CIHI? 29
Continue to explore broader opportunities > Further supporting NRS case mix applications Annual updates to cost weights and trim points Support use in funding formulae and other applications > Additional measures in Special Projects Field More specificity for particular client groups; standardized > Inclusion of more Participation information > Additional real-time algorithms and outputs Dashboards for clinicians and program managers 30
Continue to explore broader opportunities > Incorporation of outpatient rehabilitation services Leverage flexibility of the existing reporting system > Further provincial reporting in public Quick Stats > Additional cross-continuum, system-level analyses > Enhancing rehabilitation information in hospital acute inpatient services data Stakeholders requesting CIHI support of the AlphaFIM instrument for use in provincial stroke strategies 31
How to access and influence inpatient rehabilitation services data? 32
Many opportunities to access and influence inpatient rehabilitation data > As a rehabilitation clinician in all hospital and non-hospital settings > As a rehabilitation or health systems researcher > As a health system decision-maker at the program, hospital, region, and provincial levels > As a front-line data collector in a participating hospital > As a member of the CIHI National Advisory Committee several from University of Toronto over the years > As a member of the public 33
Where to access and influence inpatient rehabilitation data? > Through contacts at a participating NRS facility > On the web: www.cihi.ca/nrs for general information and various NRS analytical reports > On the web: www.cihi.ca, then Quick Stats for publicly-available, interactive NRS indicators > On the web: www.cihi.ca, then search data request for information on CIHI s data request processes > By email to the CIHI rehabilitation team: nrs@cihi.ca > By direct contact: ijoiner@cihi.ca or 613-694-6487 34
Recap of key points for this presentation 35
Key points for this presentation > Not-for-profit Canadian Institute for Health Information > Inpatient rehabilitation services data and indicators > Participating facilities in 9 of 10 Canadian provinces > Broad data set, with FIM instrument at the core > More transparency with facility-identifiable reporting > Exploring opportunities for international comparisons > Ongoing refinement of data set, indicators, and reports > Emerging opportunities for other rehabilitation settings and broader cross-continuum analyses 36
Thank You Ian Joiner Manager, Rehabilitation and Mental Health www.cihi.ca/nrs 37