TY - JOUR A1 - Hopfe, Maren A1 - Stucki, Gerold A1 - Bickenbach, Jerome E. A1 - Prodinger, Birgit T1 - Accounting for what matters to patients in the G-DRG System: A stakeholder’s perspective on integrating functioning information JF - Health Services Insights N2 - Functioning information constitutes a relevant component for determining patients’ service needs and respective resource use. Diagnosis-Related Group (DRG) systems can be optimized by integrating functioning information. First steps toward accounting for functioning information in the German DRG (G-DRG) system have been made; yet, there is no systematic integration of functioning information. The G-DRG system is part of the health system; it is embedded in and as such dependent on various stakeholders and vested interests. This study explores the stakeholder’s perspective on integrating functioning information in the G-DRG system. A qualitative interview study was conducted with national stakeholders in 4 groups of the G-DRG system (health policy, administration, development, and consultations). Interviews were analyzed using inductive thematic analysis. In total, 14 interviews were conducted (4 administration and 10 consultation group). Three main themes were identified: (1) functioning information in the G-DRG system: opportunities and obstacles, (2) general aspects concerning optimizing G-DRG systems by integrating additional information, and (3) ideas and requirements on how to proceed. The study offers insights into the opportunities and obstacles of integrating functioning information in the G-DRG system. The relevance of functioning information was evident. However, the value of functioning information for the G-DRG system was seen critically. Integrating functioning information alone does not seem to be sufficient and a systems approach is needed. KW - G-DRG System KW - Functioning information KW - Stakeholder interviews Y1 - 2018 UR - https://doi.org/10.1177%2F1178632918796776 IS - 11 SP - 1 EP - 10 ER - TY - JOUR A1 - Ehrmann, Cristina A1 - Prodinger, Birgit A1 - Gmünder, Hans Peter A1 - Hug, Kerstin A1 - Bickenbach, Jerome E. A1 - Stucki, Gerold T1 - Describing Functioning in People Living With Spinal Cord Injury in Switzerland: A Graphical Modeling Approach JF - Archives of Physical Medicine and Rehabilitation N2 - Objective: To describe functioning in people living with spinal cord injuries (SCI) in Switzerland. Design: Secondary analysis of cross-sectional survey data. Setting Community, Switzerland. Participants: Individuals (N=1549) 16 years of age or older with a history of traumatic or nontraumatic SCI and permanently residing in Switzerland. Interventions: Not applicable. Main Outcome Measures: Functioning was operationalized through 4 domains: (1) impairments in body functions; (2) impairments in mental functions; (3) independence in performing activities; and (4) performance problems in participation. Results: Univariate analysis indicated a high prevalence of problems in 5 areas: (1) housework; (2) climbing stairs; (3) tiredness; (4) spasticity; and (5) chronic pain. Graphical modeling showed a strong association among the four domains of functioning. Moreover, we found that the differences in the dependence structures were significant between the paraplegia SCI population and the tetraplegia SCI population. Conclusions: This study is a first study in the epidemiology of functioning of people living with SCI in Switzerland. Using univariate and graphical modeling approaches, we proposed an empirical foundation for developing hypotheses on functioning in each domain and category that could inform health systems on people’s health needs. KW - DAG (directed acrylic graph) KW - ICF KW - SCI (Spinal cord injuries) Y1 - 2018 UR - https://doi.org/10.1016/j.apmr.2018.04.015 VL - 99 IS - 10 SP - 1965 EP - 1981 PB - Elsevier ER - TY - JOUR A1 - Maritz, Roxanne A1 - Tennant, Alan A1 - Fellinghauer, Carolina A1 - Stucki, Gerold A1 - Prodinger, Birgit T1 - Creating a common metric based on existing activities of daily living tools to enable standardized reporting of functioning outcomes achieved during rehabilitation JF - Journal of Rehabilitation Medicine N2 - Objective: Many different assessment tools are used to assess functioning in rehabilitation; this limits the comparability and aggregation of respective data. The aim of this study was to outline the development of an International Classification of Functioning, Disability and Health (ICF)-based interval-scaled common metric for 2 assessment tools assessing activities of daily living: the Functional Independence Measure (FIMTM) and the Extended Barthel Index (EBI), used in Swiss national rehabilitation quality reports. Methods: The conceptual equivalence of the 2 tools was assessed through their linking to the ICF. The Rasch measurement model was then applied to create a common metric including FIMTM and EBI. Subjects: Secondary analysis of a sample of 265 neurological patients from 5 Swiss clinics. Results: ICF linking found conceptual coherency of the tools. An interval-scaled common metric, including FIMTM and EBI, could be established, given fit to the Rasch model in the related analyses. Conclusion: The ICF-based and interval-scaled common metric enables comparison of patients and clinics functioning outcomes when different activities of daily living tools are used. The common metric can be included in a Standardized Assessment and Reporting System for functioning information in order to enable data aggregation and comparability. Keywords: Barthel Index; Functional Independence Measure; Rasch Measurement Model; activities of daily living; outcome assessment (healthcare); psychometrics; quality in healthcare; rehabilitation. KW - Barthel Index; Functional Independence Measure; Rasch Measurement Model; activities of daily living; outcome assessment (healthcare); psychometrics; quality in healthcare; rehabilitation. Y1 - 2020 UR - https://doi.org/10.2340/16501977-2711 VL - 52 IS - 7 ER - TY - JOUR A1 - Hodel, Jsabel A1 - Ehrmann, Cristina A1 - Scheel-Sailer, Anke A1 - Stucki, Gerold A1 - Bickenbach, Jerome E. A1 - Prodinger, Birgit T1 - Identification of Classes of Functioning Trajectories and Their Predictors in Individuals With Spinal Cord Injury Attending Initial Rehabilitation in Switzerland JF - Archives of Rehabilitation Research and Clinical Translation N2 - Objectives: To identify classes of functioning trajectories in individuals with spinal cord injury (SCI) undergoing initial rehabilitation after injury and to examine potential predictors of class membership to inform clinical planning of the rehabilitation process. Design: Longitudinal analysis of the individual's rehabilitation stay using data from the Inception Cohort of the Swiss Spinal Cord Injury Cohort Study (SwiSCI). Setting: Initial rehabilitation in specialized centers in Switzerland. Participants: Individuals with newly acquired SCI (N=748; mean age, 54.66±18.38y) who completed initial rehabilitation between May 2013 and September 2019. The cohort was primarily composed of men (67.51%), persons with paraplegia (56.15%), incomplete injuries (67.51%), and traumatic etiologies (55.48%). Interventions: Not applicable. Main Outcome Measures: Functioning was operationalized with the interval-based sum score of the Spinal Cord Independence Measure version III (SCIM III). For each individual, the SCIM III sum score was assessed at up to 4 time points during rehabilitation stay. The corresponding time of assessment was recorded by the difference in days between the SCIM III assessment and admission to the rehabilitation program. Results: Latent process mixed model analysis revealed 4 classes of functioning trajectories within the present sample. Class-specific predicted mean functioning trajectories describe stable high functioning (n=307; 41.04%), early functioning improvement (n=39; 5.21%), moderate functioning improvement (n=287; 38.37%), and slow functioning improvement (n=115; 15.37%), respectively. Out of 12 tested factors, multinomial logistic regression showed that age, injury level, injury severity, and ventilator assistance were robust predictors that could distinguish between identified classes of functioning trajectories in the present sample. Conclusions: The current study establishes a foundation for future research on the course of functioning of individuals with SCI in initial rehabilitation by identifying classes of functioning trajectories. This supports the development of specifically tailored rehabilitation programs and prediction models, which can be integrated into clinical rehabilitation planning. KW - Latent class analysis KW - Logistic models KW - Longitudinal studies KW - Observational study KW - Rehabilitation KW - Spinal cord injuries Y1 - 2021 UR - https://doi.org/10.1016/j.arrct.2021.100121 VL - 3 IS - 2 SP - 100121 ER - TY - JOUR A1 - Hodel, Jsabel A1 - Stucki, Gerold A1 - Prodinger, Birgit T1 - The potential of prediction models of functioning remains to be fully exploited: A scoping review in the field of spinal cord injury rehabilitation JF - Journal of Clinical Epidemiology N2 - Objective: The study aimed to explore existing prediction models of functioning in spinal cord injury (SCI). Study design and setting: The databases PubMed, EBSCOhost CINAHL Complete, and IEEE Xplore were searched for relevant literature. The search strategy included published search filters for prediction model and impact studies, index terms and keywords for SCI, and relevant outcome measures able to assess functioning as reflected in the International Classification of Functioning, Disability and Health (ICF). The search was completed in October 2020. Results: We identified seven prediction model studies reporting twelve prediction models of functioning. The identified prediction models were mainly envisioned to be used for rehabilitation planning, however, also other possible applications were stated. The method predominantly used was regression analysis and the investigated predictors covered mainly the ICF components of body functions and activities and participation, next to characteristics of the health condition and health interventions. Conclusion: Findings suggest that the development of prediction models of functioning for use in clinical practice remains to be fully exploited. By providing a comprehensive overview of what has been done, this review informs future research on prediction models of functioning in SCI and contributes to an efficient use of research evidence. KW - Spinal Cord Injuries KW - Rehabilitation KW - Prognosis KW - Diagnosis KW - Clinical Decision Rules KW - Forecasting Y1 - 2021 UR - https://doi.org/10.1016/j.jclinepi.2021.07.015 VL - 139 SP - 177 EP - 190 ER -