What is the FIM™ instrument*?
The FIM™ instrument is a basic indicator of severity of disability. The functional ability of a patient changes during rehabilitation and the FIM™ instrument is used to track those changes which are a key outcome measure of rehabilitation episodes.
The FIM™ instrument comprises 18 items, each of which is assessed against a seven point ordinal scale, where the higher the score for an item, the more independently the patient is able to perform the tasks assessed by that item. Total scores range from 18 to 126. The items are divided into two major groups, the Motor items, of which there are 13, and the Cognitive Items, of which there are 5. The rating scale designates major graduations in behaviour from dependence to independence. The scale provides for the classification of individuals by their ability to carry out an activity independently, versus their need for assistance from another person or a device. If help is needed the scale assesses the degree of that need.
Prior to 1984 clinicians had no universally accepted terminology to communicate about disability. To address this issue, the National Institute on Disability and Rehabilitation Research of the US Dept Education awarded a grant to the Dept of Rehabilitation Medicine, School of Medicine and Biomedical Sciences at the State University of New York at Buffalo to develop a system to document severity of patient disability and the outcomes of medical rehabilitation.
A task force representing the US rehabilitation community set about developing the Uniform Data System for Medical Rehabilitation (UDSMR) a minimum data set that includes a rating scale to measure function, the Functional Independence Measure (FIM™ instrument ). It is now widely used around the world, including in Australia.
AROC holds the territory license for the use of the FIM™ (and WeeFIM®) instruments in Australia, and is the national certification and training centre for these tools. All clinicians undertaking assessments are trained in the use of the tools, and must sit a credentialing exam every two years. In Australia there are three levels of credentialing: clinician, facility trainer and master trainer.
Function is assessed using the FIM™ instrument at admission and discharge. Admission data is collected within 72 hours of admission, and discharge data is collected within the 72 hours prior to discharge. Assessment is undertaken by direct observation by clinicians familiar with the patient’s daily activities, and is often a multidisciplinary process. The score should reflect the actual performance observed.
The timing of the admission scoring is important because clinically, a person’s functional capacity changes upon commencement of a program of rehabilitation. To achieve an accurate base measure it is important that the initial measurement is done in a timely manner. Similarly, it is important that the discharge assessment is done within a time frame that allows the total functional improvement of the patient to be measured. To measure the timeliness of scoring on admission and discharge the AROC data set requires the collection of the date on which each of these scores was achieved. It should also be noted that timeliness of functional assessment on admission and discharge is an ACHS Rehabilitation Medicine clinical indicator.
TERMINOLOGY CHANGES — RESIDENTIAL CARE (AUSTRALIA)
As at 1 July 2014 the Australian Government changed the definition of residential care resulting in “low level care” and “high level care” no longer being current terminology (more details). The AROC V4 Dataset for Australia and the Australian Data Collection Forms for pathways 2, 3, 4 & 5 still have this concept in the data items “Type of Accommodation prior to the impairment”, “Interim Accommodation post discharge” and “Final Accommodation post discharge”. The ramifications of this definitional change was discussed by the AROC Scientific Clinical Advisory Committee. It was agreed that whilst AROC can’t change the V4 code set for the three affected data items mid-stream, we can introduce a new business rule that takes account of this definitional change.
New business rule for Australian facilities: All episodes admitted from or discharged to residential care from July 2014 are to be coded to residential high level care (nursing home).
NOTE: all future analyses on Australian admissions from / discharges to residential care will combine residential low level care (hostel) and residential high level care (nursing home). When the AROC V4 dataset is revised the Accommodation data items affected by this definitional change will be adjusted to include codes identifying the 4 levels of care packages at home now available, as well as residential aged care and a code identifying referral to NDIS.
- Rehabilitation Care Plan - Anywhere Hospital
- AN-SNAP Classification Version 3 (Released January 2012, NB: Rehabilitation classes are unchanged)
- AN-SNAP Calculator (Excel 2007+)
- Inpatient Clinical Data Set
- Ambulatory Clinical Data Set
- Impairment Specific Data Items
- Australian Impairment Codes
- Guidelines for Coding Impairments
- Data submission dates
- Order of Australia Award for AROC Clinical Director