The report is available in English with a French summary - KCE

KCE reports 57 Musculoskeletal & Neurological Rehabilitation 37
3.5.2.7 Programme de Médicalisation du Système d'Information – Soins de Suite et de
Réadaptation 99
Origin: PMSI-SSI has been developed in France in 1998. It not only includes post-acute
rehabilitation, but also geriatric care, palliative care, alcoholabuse, and rehabilitation for
children. Psychiatric care and long-term (“chronic”) care are excluded. It is based on
medical diagnosis combined with an assessment of functional impairment and a description
of resource utilisation (time attributed to physiotherapy, speech therapy…). Evaluation of
the patient has to be completed once every week (instead of once per care episode). The
system has been criticised on three points: the large inclusion criteria which weakens its
ability to predict costs per category, the large time investment (to be completed once
every week); the fact that resource utilisation (and not only patient characteristics) is
taken into account to develop case-mix groups.
Outcome measure: Diagnosis, a measure for dependence and a measure for the utilisation
of resources.
Implementation: Funding of rehabilitation in France.
3.5.2.8 TAR-FIM 99
Origin: TAR-FIM was developed by a team in Switzerland specific for neurological
rehabilitation.
Oucome measure: Diagnosis, a measure for dependence and a measure for the
consumption of resources.
Implementation: TAR-FIM was subject of an experiment. It is not clear if it was
implemented.
3.5.3 Outpatient classifications
3.5.3.1 Home Health Resource Groups
98, 108
Origin: The implementation of the prospective payment system for home health care in
October 2000 in the USA.
Outcome measures: Outcome and Assessment Information Set (OASIS). OASIS is
developed by the Centre for Health Services Research at the University of Colorado in
the late 1980s and early to mid 1990s. The Oasis items were designed to measure, assess,
and encourage improvement in care outcomes over time using Outcome-Based Quality
Improvement processes.
Implementation: With the implementation of the prospective payment system for home
health care in October 2000, information collected via OASIS was used for case-mix
adjustment in establishing Medicare reimbursement. Overall, OASIS is used for outcome
monitoring, payment, and as a core but not comprehensive clinical assessment.
3.5.3.2 Ambulatory Visit Groups 109-111
Origin: Ambulatory Visit Groups (AVGs) were developed in the 1980’s by the Health
Systems research group at Yale University (USA).
“Ambulatory care has particular problems in the construction of appropriate case-mix
measures, and day-case surgery provides an opportunity to test two existing measures,
one inpatient (Diagnosis Related Groups) and one ambulatory (Ambulatory Visit Groups).
These grouping systems were applied to the same data to compare the case-mix patterns
that they produce. The findings show that Ambulatory Visit Groups appear to have
advantages over the Diagnosis Related Groups with respect to their underlying
assumptions and labelling of the groups; in particular, they assign greater weight to
procedures. However, Diagnosis Related Groups are more developed, easier to use, more
familiar and allow direct comparisons with inpatient care. Nevertheless, a proper
evaluation of these issues requires further data collection and analysis, together with a
fundamental examination of the uses of ambulatory case-mix.” 109