Search tips
Search criteria 


Logo of hsresearchLink to Publisher's site
Health Serv Res. 1997 October; 32(4): 529–548.
PMCID: PMC1070209

Development of function-related groups version 2.0: a classification system for medical rehabilitation.


OBJECTIVE: To present a new version (2.0) of the Functional Independence Measure-Function Related Group (FIM-FRG) case-mix measure. DATA SOURCE/STUDY SETTING: 85,447 patient discharges from 252 freestanding facilities and hospital units contained in the 1992 Uniform Data System for Medical Rehabilitation. STUDY DESIGN: Patient impairment category, functional status at admission to rehabilitation, and patient age were used to develop groups that were homogeneous with respect to length of stay. Within each impairment category patients were randomly assigned to one data set to create the system (through recursive partitioning) or a second set for validation. Clinical and statistical criteria were used to increase the percentage of patients classified, expand the impairment categories of FIM-FRGs Version 1.1, and evaluate the incremental predictive ability of coexisting medical diagnoses. Predictive stability over time was evaluated using 1990 discharges. PRINCIPAL FINDINGS: In Version 2.0, the percentage of patients classified was increased to 92 percent. Version 2.0 includes two new impairment categories and separate groups for patients admitted to rehabilitation for evaluation only. Coexisting medical diagnoses did not improve LOS prediction. The system explains 31.7 percent of the variance in the logarithm of LOS in the 1992 validation sample, and 31.0 percent in 1990 discharges. CONCLUSIONS: FIM-FRGs Version 2.0 includes more specific impairment categories, classifies a higher percentage of patient discharges, and appears sufficiently stable over time to form the basis of a payment system for inpatient medical rehabilitation.

Full text

Full text is available as a scanned copy of the original print version. Get a printable copy (PDF file) of the complete article (1.6M), or click on a page image below to browse page by page. Links to PubMed are also available for Selected References.

Selected References

These references are in PubMed. This may not be the complete list of references from this article.
  • Aitchison KW. Rehabilitation at the crossroads. Financial and other considerations. Am J Phys Med Rehabil. 1993 Dec;72(6):405–407. [PubMed]
  • Hamilton BB, Laughlin JA, Fiedler RC, Granger CV. Interrater reliability of the 7-level functional independence measure (FIM) Scand J Rehabil Med. 1994 Sep;26(3):115–119. [PubMed]
  • Harada N, Kominski G, Sofaer S. Development of a resource-based patient classification scheme for rehabilitation. Inquiry. 1993 Spring;30(1):54–63. [PubMed]
  • Langenbrunner JC, Willis P, Jencks SF, Dobson A, Iezzoni L. Developing payment refinements and reforms under Medicare for excluded hospitals. Health Care Financ Rev. 1989 Spring;10(3):91–107. [PubMed]
  • Linacre JM, Heinemann AW, Wright BD, Granger CV, Hamilton BB. The structure and stability of the Functional Independence Measure. Arch Phys Med Rehabil. 1994 Feb;75(2):127–132. [PubMed]
  • Stineman MG, Escarce JJ, Goin JE, Hamilton BB, Granger CV, Williams SV. A case-mix classification system for medical rehabilitation. Med Care. 1994 Apr;32(4):366–379. [PubMed]
  • Stineman MG, Hamilton BB, Granger CV, Goin JE, Escarce JJ, Williams SV. Four methods for characterizing disability in the formation of function related groups. Arch Phys Med Rehabil. 1994 Dec;75(12):1277–1283. [PubMed]
  • Stineman MG, Shea JA, Jette A, Tassoni CJ, Ottenbacher KJ, Fiedler R, Granger CV. The Functional Independence Measure: tests of scaling assumptions, structure, and reliability across 20 diverse impairment categories. Arch Phys Med Rehabil. 1996 Nov;77(11):1101–1108. [PubMed]

Articles from Health Services Research are provided here courtesy of Health Research & Educational Trust