This proposal describes a five year program of career development for Margaret Stineman, M.D. involving 80% research, 15% clinical activities, and 5% teaching. The research hypothesizes that it will be possible to predict outcomes, and the likelihood of medical complications, in elderly persons undergoing Comprehensive Inpatient Medical Rehabilitation (CIMR) based on presenting characteristics. The long term objective will be to develop a generalized Multiple Diagnostic Category Staging (MDCS) system to predict the recovery potential of persons aged 65 years or older undergoing CIMR, and a second, more specific, prognostic staging system for people with stroke. A similar set of indices will be derived for both staging systems. These indices will quantify how age, functional status, medical impairment(s), and an individual's socioeconomic circumstances interact to influence three spheres of the rehabilitation process: (I) functional status recovery (2) achievement of home discharge following CIMR: (3) the likelihood of medical complications that confound or interrupt rehabilitation. The indices will be derived via multivariable regression analyses of several large CIMR data sets. A follow-up investigation could consist of a trial in which the CIMR staging systems would be applied to an experimental group and withheld from a control group of patients. Ongoing and potential future studies of various rehabilitation and treatment strategies for functionally impaired elderly patients are described. This application identifies two sponsors: one with extensive expertise in decision analysis and health services research, and a second who is internationally recognized in rehabilitation and functional status research. Because of the multidisciplinary nature of the research questions, the application additionally describes individuals who have agreed to provide advice in the areas of geriatrics, geriatric psychology, aging, psychometric instrumentation, and statistics. Clinical activities will include an outpatient geriatric-rehabilitation practice, and the supervision of resident physicians rotating through CIMR. Teaching activities will be directed towards integrating principles of geriatric rehabilitation and research into undergraduate, graduate, and post-graduate training.
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