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Indicator Metadata

NameInpatient Rehabilitation Length of Stay Efficiency
Short/Other Names

Inpatient Rehabilitation LOS Efficiency

Description

The average change in Total Function Score per day of client participation in the inpatient rehabilitation program

Function Scores referenced herein are based on data collected using the FIM® instrument. The 18-item FIM® instrument is the property of Uniform Data System for Medical Rehabilitation, a division of UB Foundation Activities, Inc.

InterpretationA higher value indicates that clients experienced greater improvements in Total Function Score per day of inpatient rehabilitation, on average; a lower value indicates less improvement. As such, a higher average value is desirable.
HSP Framework Dimension

Health System Outputs: Efficiently delivered

Areas of Need

Getting Better

Geographic Coverage

All provinces/territories except Quebec

Reporting Level/Disaggregation

National, Province/Territory

Indicator Results

https://apps.cihi.ca/mstrapp/asp/Main.aspx?Server=apmstrextprd_i&project=Quick%20Stats&uid=pce_pub_en&pwd=&evt=2048001&visualizationMode=0&documentID=26E34D3240B38F51BE8E2DBB8F88826A

Identifying Information
NameInpatient Rehabilitation Length of Stay Efficiency
Short/Other Names

Inpatient Rehabilitation LOS Efficiency

Indicator Description and Calculation
Description

The average change in Total Function Score per day of client participation in the inpatient rehabilitation program

Function Scores referenced herein are based on data collected using the FIM® instrument. The 18-item FIM® instrument is the property of Uniform Data System for Medical Rehabilitation, a division of UB Foundation Activities, Inc.

Calculation: Description

This indicator is calculated annually for the most recently completed seven fiscal years. Calculation is based on Total Function Score Change (Total Function Score at Discharge from inpatient rehabilitation minus Total Function Score at Admission to inpatient rehabilitation) divided by inpatient rehabilitation length of stay (LOS) for each client, averaged over the number of clients for whom such Function Scores have been recorded.

Periods within the rehabilitation episode during which a client did not participate in therapy due to an acute change in health status (Service Interruption Days) are removed from the calculation of rehabilitation LOS used in this formula.

Excludes clients with incomplete admission and discharge Function Scores

Unit of Analysis: Episode of care

Calculation: Geographic Assignment

Place of service

Calculation: Type of Measurement

Average or mean

Calculation: Adjustment Applied

None

Calculation: Method of Adjustment

Not applicable

Denominator

Description:
Total number of clients discharged from an NRS-participating inpatient rehabilitation facility with complete admission and discharge Total Function Scores

Exclusions:
1. Clients with incomplete admission and discharge Function Scores

Numerator

Description:
Change in Total Function Score per day of client participation in the rehabilitation program, summed across all clients discharged from an NRS-participating inpatient rehabilitation facility with complete admission and discharge Function Scores recorded
Exclusions:
1. Clients with incomplete admission and discharge Function Scores

2. Days of client participation in the rehabilitation program = LOS minus days spent on therapy service interruption (client not receiving rehabilitation)

Background, Interpretation and Benchmarks
Rationale

The LOS Efficiency indicator is based on two other NRS indicators—change in Total Function Score and LOS—both of which are commonly referenced measures of rehabilitation service performance. This indicator provides a means of normalizing the amount of function change occurring by the amount of time spent in rehabilitation.

Interpretation

A higher value indicates that clients experienced greater improvements in Total Function Score per day of inpatient rehabilitation, on average; a lower value indicates less improvement. As such, a higher average value is desirable.

HSP Framework Dimension

Health System Outputs: Efficiently delivered

Areas of Need

Getting Better

Targets/Benchmarks

There are no pan-Canadian benchmarks.

References

Not applicable

Availability of Data Sources and Results
Data Sources

NRS

Available Data Years

Type of Year:
Fiscal
First Available Year:
2009
Last Available Year:
2015

Geographic Coverage

All provinces/territories except Quebec

Reporting Level/Disaggregation

National, Province/Territory

Result Updates
Update Frequency

Every year

Indicator Results

Web Tool:
Quick Stats
URL: https://apps.cihi.ca/mstrapp/asp/Main.aspx?Server=apmstrextprd_i&project=Quick%20Stats&uid=pce_pub_en&pwd=&evt=2048001&visualizationMode=0&documentID=26E34D3240B38F51BE8E2DBB8F88826A

Updates

Not applicable

Quality Statement
Caveats and Limitations

The NRS frame does not currently contain all inpatient rehabilitation units/facilities in all provinces and territories. Coverage is less than 100% in all jurisdictions except Ontario, P.E.I. and Newfoundland.

The LOS Efficiency indicator is based on two other NRS indicators—change in Total Function Score and LOS—both of which can be influenced by multiple factors. Care should be exercised when comparing this indicator between facilities or jurisdictions.

Trending Issues

Since 2006, the number of facilities and jurisdictions submitting to the NRS has fluctuated slightly. As well, some policies have changed in some provinces, which may have influenced average LOS, such as interests in decreasing LOS and/or the amount of client function change that is possible. These may include changes affecting characteristics of the inpatient rehabilitation population that is admitted and changes affecting the clinical status at which people are deemed suitable for discharge. Due to these changes, any indicator trends identified need to be interpreted carefully, as they may reflect changes in the underlying population or service levels rather than actual changes in rehabilitation effectiveness.

Comments

In addition to the average (mean) Length of Stay Efficiency, the Quick Stats report NRS Length of Stay and Length of Stay Efficiency of Inpatient Rehabilitation Clients also provides the median Length of Stay (in days) and the number of cases (episodes) being included in both calculations.

The number of cases, mean and median values in this report can be further subdivided by Rehabilitation Client Group (the rehabilitation condition that best describes the primary reason for admission to the rehabilitation program) and by fiscal year.

Rehabilitation Client Groups (RCGs) referenced in the Quick Stats report NRS Distribution of Days Waiting for Admission to Inpatient Rehabilitation are adapted with permission from the UDSMR impairment codes. Copyright 1997 Uniform Data System for Medical Rehabilitation, a division of UB Foundation Activities, Inc., all rights reserved.