Biomedical subjects

K M Kilgore

Publications and source records attributed to K M Kilgore.

8 recordsLinked to original sources

PubMed1995

Measuring outcomes in the postacute continuum.

Measuring outcomes across the postacute continuum presents both practical and technical challenges. It requires capturing a variety of information across multiple therapeutic disciplines and care settings. While this information is collapsed into a single patient record, the ability to assess the contribution of each component to the overall outcome must be retained. Current health care data systems tend to fragment the information into discrete stays. Extant outcome instruments are perceived as being insensitive to change in noninpatient settings. The technology exists to correct shortcomings in both the information and the outcome assessment systems. The latter difficulties are the more complex, but by understanding the relationship between the measuring instrument and what it measures, and by properly matching the instrument to the level of the patient and the goals of the treatment program, many obstacles to effective outcomes management in the postacute continuum can be overcome. In a time of rapid change and experimentation in health care, however, outcomes managers must recognize that negative outcome data can result from ineffective programs as well as inappropriate instruments.

Continuity of Patient Care↗

PubMed1995

Rehabits: a common language of functional assessment.

Probabilistic measurement models offered by Rasch and others can be used to link different functional assessment instruments into a single measurement system. This study assessed 54 subjects (diagnoses: 8 brain injuries, 7 neuromuscular, 22 musculoskeletal, 7 spinal cord, 10 stroke) admitted to a free-standing rehabilitation hospital at admission and discharge using both the Functional Independence Measure (FIM) and the Patient Evaluation and Conference System (PECS). Thirteen FIM and 22 PECS motor skills items were scaled together into a 35-item instrument, providing scale values for all items in the same unit of measurement. Separate FIM and PECS measures produced for each subject correlate .94 and .91 (p < .0001), respectively, with the cocalibration measures, and 0.91 (p < .0001) with each other. Either instrument's ratings are easily and quickly converted into the other's using the common unit of measurement, the rehabit (rehabilitation measuring unit). This article argues that the stability of the PECS and FIM item difficulty estimates over thousands of subjects, dozens of hospitals, hundreds of raters, and years of assessment is convincing evidence in support of the widespread use of their cocalibrated, common scale values as a functionometric ruler.

Calibration↗

PubMed1993

Object relations and social functioning of schizophrenic and borderline patients: a cross-sectional developmental perspective.

Using a cross-sectional design, this study compared patients with schizophrenic and borderline personality disorders on measures of object relations and social functioning. Although we found that on measures of object relations the borderline group remained less impaired than the schizophrenics, during the course of the lifespan the schizophrenic patients appeared to surpass the borderlines on social functioning. These results are integrated with the literature that compares the long-term course and outcomes for these disorders and are discussed within the context of differential adaptive capacities, change mechanisms, and treatment interventions.

Adult↗

PubMed1992

Applying psychometric criteria to functional assessment in medical rehabilitation: III. Construct validity and predicting level of care.

A discriminant analysis was performed using Rasch ability estimates derived from four Patient Evaluation and Conference System (PECS) subscales, to distinguish among the functional independence and impairment profiles exhibited by patients admitted into any of three levels of medical rehabilitation delineated by the National Association of Rehabilitation Facilities (NARF): (1) inpatient hospital, (2) atypical nursing home (intermediate), or (3) day program. Two discriminant functions accounted for 91% and 9% of the between-group variance, respectively. Cross-validated classification of patients into one of the three levels of care, based on discriminant function scores, produced 75% correct classification; a 66% improvement over the percentage of correct classification likely by chance alone. Results support the construct validity of the PECS subscales and indicate they may be useful in validating clinically-based admission decisions among three of the levels of care promulgated by NARF.

Activities of Daily Living↗

PubMed1992

Predicting return to work in traumatic brain injury using assessment scales.

This study compared two frequently used brain injury assessment scales with a comprehensive functional scale in their capability to predict return to work in a traumatic brain injured population. Fifty-seven consecutive admissions to an inpatient brain injury program were rated at admission and discharge using the following scales: Patient Evaluation and Conference System (PECS), Disability Rating Scale, and Levels of Cognitive Functioning Scale. Their relative accuracy in predicting return to work or school up to 26 months after the injury was assessed using hierarchical logistic regression analysis. In each analysis, return to work/school was the dependent variable. The independent variables were initial status and discharge status on each rating scale. Overall these scales predicted return to work with 73.5% to 84.4% accuracy. Total PECS and PECS Cognition scores were the most accurate predictors. Analysis of incorrect predictions revealed the importance of additionally tracking the social factors of substance abuse, family/community support and financial need to return to work.

Activities of Daily Living↗

PubMed1992

Applying psychometric criteria to functional assessment in medical rehabilitation: II. Defining interval measures.

The use of functional assessment total scores in arithmetic operations has proliferated despite the lack of evidence supporting their use as interval measures of patient ability. Such evidence is minimally necessary to assure the validity of functional assessment total scores for clinical and management decision-making. Two requirements of interval measurement are explained and a set of Rasch analyses of 5,500 assessments using the Patient Evaluation and Conference System (PECS) are presented. The analyses were performed to determine the extent to which four item subsets identified in a previously reported factor analysis of the PECS comprise interval measures of functional independence status. Results indicate that the PECS scales meet these requirements to varying degrees. The analyses also identify areas in which measurement quality can be improved.

Activities of Daily Living↗

PubMed1991

Applying psychometric criteria to functional assessment in medical rehabilitation: I. Exploring unidimensionality.

While rehabilitation providers are facing increasing pressure to document treatment outcomes, critics have warned against the inappropriate use of ordinal functional assessment data in arithmetic operations. Two salient criticisms concern the combination of items representing multidimensional abilities into a single total score, and the indeterminate distances between hierarchical functional assessment scale categories. In this initial study, the factor structure of the Patient Evaluation and Conference System (PECS) was studied to assess the potential for unidimensional measurement. Factor analysis of a multidiagnostic dataset (n = 3,564) yielded eight factors accounting for 60% of the variance among 68 PECS items. The factors indicate that several unidimensional measures may underlie the PECS. These factors are delineated, and further studies of unidimensionality and additivity are recommended.

Activities of Daily Living↗

PubMed1990

Social dimensions to functional gain in pediatric patients.

Rehabilitation hospitals recognize the need for holistic patient care and employ professionals who are concerned with the social dimensions of functional independence. However, there have been few empirical studies of the relationship between social variables and functional gain. Functional assessment data for 66 pediatric patients admitted to an inpatient rehabilitation program were analyzed. Regressing residual gain scores on social variables from the Patient Evaluation and Conference System (a patient tracking data base) showed significance (p less than .01) in pediatric functional gain. Patients whose families were less able to support their independent living before admission made the greatest functional gains. Family support for disabled pediatric patients affected functional gain, affirming the importance of rehabilitation professionals' involvement with the patient's social needs throughout the rehabilitation process.

Activities of Daily Living↗