Evaluating the VHA health care system service structure, processes, and outcomes is contingent upon an integrated information system that monitors a Veteran's functional status across the continuum of care (acute, post-acute and community care). VA health professionals use a variety of functional instruments across different health care settings. Thus, when Veterans move from one setting to another, researchers, managers, and clinicians are often challenged to track functional status changes efficiently and precisely. In particular, researcher and clinicians face challenges when comparing results derived from the Functional Independence Measure (FIMTM), which is collected to monitor functional outcomes in VA inpatient rehabilitation facilities (IRFs), and results obtained from the Minimum Data Set (MDS) of the Resident Assessment Instrument (RAI), which is collected to monitor functional status in VA Community Living Centers (CLC). While considerable resources have been invested in developing and implementing these instruments, they are limited in their ability to "speak" to one another. This limitation is referred to as "test-dependency." Currently, data gathered using the FIM cannot be readily compared to similar data gathered with the MDS. The broad, long-term objective of this proposed research is to advance Veteran health care delivery by providing the VHA with a state-of-the-art measurement system that builds upon the well-established VHA infrastructure use of the FIM in IRFs and the MDS in CLCs. The proposed measurement system will use contemporary item banking methodologies to provide practitioners with: 1) measures that translate between the two instruments, 2) flexibility in test administration (e.g., practitioners can choose to administer either the FIM or MDS in their entirety or in abbreviated forms), 3) reduced administration and Veteran burden through the use of short forms and computer adaptive test administration, and 4) equiprecise measurement (i.e., "equal" measurement precision across patient diagnosis severity).
The Specific Aims of this study are to: 1) Create a FIM-MDS item bank that meets Item Response Theory (IRT) model requirements;2) Generate IRT-based short forms and computer adaptive tests from the item bank;3) Compare the precision of the IRT-based short forms, computer adaptive tests and item bank to the original FIM and MDS measures;and 4) Assess the accuracy of the IRT- based short forms, computer adaptive tests and item bank in classifying patients into Function Related Groups.
This research has the potential to dramatically advance the monitoring of Veteran functional status as they transition through different VHA healthcare settings. By combining the physical functioning items and combining the cognition items from Functional Independence Measure (FIM) used in inpatient rehabilitation facilities (IRFs) with similar items from the Minimum Data Set (MDS) used in Community Living Centers (CLCs) we will create item banks that provide healthcare practitioners with: 1) measures that translate between the IRF and CLC settings, 2) flexibility in test administration, 3) reduced administration and patient burden, and 4) measurement precision across the breath of patient severity.