Grading: An Annotated “Pen and Paper” Approach to Multidimensional Case-Mix–Adjusted Continuous Quality Improvement

Abstract

In this article, we present a simple multidimensional approach to case-mix adjustment that can be used without sophisticated statistical or computer programs. The objectives are to synthesize and offer examples of practical applications of the principles provided in the other articles in this issue of Topics in Stroke Rehabilitation. Combining case-mix adjustment concepts presented by Berlowitz and coworkers with the educate, execute, and evaluate process presented by Needham and coworkers, the approach applies functional grading to show how to evaluate the impact on patient outcomes after major changes in the structural characteristics of an integrated rehabilitation program within a large hospital-based health system. The example is based on the vignette, Maintaining Functional Outcomes in Times of Change, which appears in the article, “Unraveling the Conundrum of Quality” in this issue.

Keywords:

• comparative effectiveness
• continuous quality improvement
• functional independence grading
• stroke