Can Administrative Claim File Review Be Used to Gather Physical Therapy, Occupational Therapy, and Psychology Payment Data and Functional Independence Measure Scores? Implications for Rehabilitation Providers in the Private Health Sector

Abstract

Purpose: Rehabilitation costs for spinal-cord injury (SCI) are increasingly borne by Canada's private health system. Because of poor outcomes, payers are questioning the value of their expenditures, but there is a paucity of data informing analysis of rehabilitation costs and outcomes. This study evaluated the feasibility of using administrative claim file review to extract rehabilitation payment data and functional status for a sample of persons with workrelated SCI. Methods: Researchers reviewed 28 administrative e-claim files for persons who sustained a work-related SCI between 1996 and 2000. Payment data were extracted for physical therapy (PT ), occupational therapy (OT ), and psychology services. Functional Independence Measure (FIM) scores were targeted as a surrogate measure for functional outcome. Feasibility was tested using an existing approach for evaluating health services data. Results: The process of administrative e-claim file review was not practical for extraction of the targeted data. Conclusions: While administrative claim files contain some rehabilitation payment and outcome data, in their present form the data are not suitable to inform rehabilitation services research. A new strategy to standardize collection, recording, and sharing of data in the rehabilitation industry should be explored as a means of promoting best practices.Key Words: occupational therapy, outcomes, outpatient, physical therapy, psychology, rehabilitation, spinal-cord injury Riis R, Jaglal S, Boschen K, Walker J, Verrier M. Can administrative claim file review be used to gather physical therapy, occupational therapy, and psychology payment data and functional independence measure scores? implications for rehabilitation providers in the private health sector. Physiother Can. 2011; 63(3);324-333; doi:10.3138/ptc.2010-25 RÉ SUMÉObjectif : Les coû ts de la ré adaptation à la suite d'une lé sion à la moelle é piniè re sont de plus en plus pris en charge par le systè me de santé privé au Canada. En raison des faibles ré sultats obtenus, les payeurs s'interrogent sur la pertinence de cette dé pense, mais il existe peu de donné es pour alimenter une ré elle analyse des coû ts et des ré sultats en ré adaptation. Cette é tude s'est penché e sur la faisabilité du recours à un examen des dossiers administratifs de ré clamations pour l'extraction de donné es relatives aux sommes consacré es à la ré adaptation et au statut fonctionnel des personnes ayant subi une lé sion à la moelle é piniè re de nature professionnelle. Mé thode : Les chercheurs ont é tudié 28 dossiers é lectroniques de ré clamation de personnes ayant subi une lé sion à la moelle é piniè re dans le cadre de leur travail entre 1996 et 2000. Des donné es sur le paiement ont é té extraites pour les services de physiothé rapie (PT), d'ergothé rapie (OT) et de psychologie. Les mesures de l'indé pendance fonctionnelle é taient visé es et ont é té utilisé es comme mesure auxiliaire des ré sultats sur le plan fonctionnel. La faisabilité a é té é valué e à l'aide d'u...

Describing the current state of post-rehabilitation health system surveillance in Ontario – an invited review

“…Other datasets, such as the WSIB claims database, typically are not designed with clinical or health outcomes research in mind and may not be suitable stand-alone sources of relevant information to dictate policy change at the community level, 39 although they may inform the role of case management services in directing resources.…”

“…Beyond the databases described in Table 1, there are a number of other potentially valuable sources of data, which may, if deployed properly, provide additional relevant information related to the health service utilization and patient needs of individuals with SCI living in the community. Despite the potential limitations of health insurance data, 39 it should be noted that health insurance providers may possess a wealth of data regarding utilization of health services, and their associated costs, among individuals with SCI living in the community.…”