FIM™ ratings are standard measures of functional independence used in classifying patients for payment in the Medicare Prospective Payment System for IRFs. Accuracy is assumed by instruction and testing of proficiency of clinical users, but relatively few clinics routinely assess FIM ratings for reliability. When FIM data is collected routinely over a patient’s length of stay, analysis of rating patterns by clinician is possible to detect patterns of disagreement between scores when the same patient is rated by multiple clinicians.
Using an aberrant ratings analysis of same item FIM observations for the same patient, ratings serially recorded within six hours of each other are labeled as aberrant (different) if they vary by more that +/- 2 FIM grades. All applicable FIM pairs are evaluated for all patients and resolved for serial agreement with neighboring same item scores along the patient’s 24 hour time continuum. All FIM ratings meeting these criteria are displayed by rater in the graphic below.
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An arbitrary threshold of performance is set at 5% to trigger attention and possible action requirements for raters who chronically exceed this level for aberrant compared with their peers.
This methodology identifies potential clinicians requiring additional instruction and competency reinforcement.