Other Diagnosis e97

behaviors. Self-care skills was measured with the Vineland Daily Living

Skills subtest at 7 years of age.

Results: Group had a direct relation with later self-care skills as well as an

indirect relation through early EF/SL skills that, in turn, had a direct

relation with later self-care independence. An indirect effect of responsive

parenting on later independence skills also was found through a direct

effect on EF/SL skills.

Conclusions: Early precursors of school age difficulties with self-care

skills observed for children with spina bifida can be explained, in part, by

difficulties in the first 3 years of life with EF/SL. Early responsive

parenting appears to positively affect the development of these EF/SL

skills. Implications for early intervention are an outcome of this study.

Key Words: spina bifida, parenting, self-care independence, executive

functions, longitudinal study

Disclosure(s): None Disclosed.

Poster 307

Validating Generic Core Set and Developmental Code Set by UsingNational Disability Sample in Taiwan

Hua-Fang Liao (Taiwan Society of ICF), Ai-Wen Hwang, Wen-Chou Chi,Tsan-Hon Liou, Chia-Feng Yen, Lin-ju Kang, Ben-Shang Chang,Ting-Fang Wu, Shu-Jen Lu

Objective: To validate the activities and participation (d) codes of the ICF-CY in the Generic Core Set (Generic-set) and the ICF-CY Developmental

Code Set (Development-set) by a national sample of children with

disabilities.

Design: A cross-sectional national survey.

Setting: A total of 236 hospitals.

Participants: A total of 23,720 dyads of children with disabilities aged

6-17.9 years and their primary caregivers.

Interventions: Not applicable.Main Outcome Measure(s): The Functioning Scale of the Disability

Evaluation System - Child version (FUNDES-Child) was used to interview

the primary caregivers for collecting d data in the Disability Eligibility

Determination System in Taiwan. The participation part of the FUNDES-

Child has 20 items with both frequency and independency dimensions.

Consensus meetings were conducted for linking items from FUNDES-

Child to ICF-CY codes. Those categories were matched with d codes in

Generic-set (nZ4) and Development-set (nZ27). The percentages of re-

striction of each linked-code were calculated.

Results: The FUNDES-Child had 2 linked-codes matching with Generic-

Set and 20 with Development-set. The only non-matched Generic code

was d850. The percentages of restriction of frequencies and dependence

were above 35% in all matched codes. The codes with higher or lower

ranking of percentage of restriction in frequency and independence di-

mensions were different.

Conclusions: The matched codes of Generic-Set and Development-Set

showed restriction rate >35% and could be used to facilitate the

description functioning. However, Generic code d850 (Remunerative

employment) is not suitable for pediatric population. Further study to

develop Generic Set for pediatrics is suggested.

Key Words: Disabled Children, Social Participation, International Classi-

fication of Functioning, Disability and Health, Validation Studies

Disclosure(s): None Disclosed.

Poster 308

Prospective Payment System Implementation and Earlier InpatientRehabilitation Admission

Jacqueline Mix (Uniform Data System for Medical Rehabilitation),Margaret A. DiVita, Paulette Niewczyk

Objective: The prospective payment system (PPS) went into effect in

October 2001. This study examines whether the average onset days to-

rehabilitation has differed from the pre-PPS period to post-PPS.

www.archives-pmr.org

Design: A retrospective cohort study using data from the Uniform Data

System for Medical Rehabilitation (UDSMR) for cases discharged be-

tween 1994 and 2000 (pre-PPS), and between 2005 and 2012 (post-PPS);

due to large case counts, a 5% random sample of cases was used.

Setting: Inpatient Rehabilitation Facilities (IRFs).

Participants: A total of 277,924 patients were included, 105,993 from the

pre-PPS period and 171,931 from the post-PPS period.

Interventions: Not applicable.Main Outcome Measure(s): Onset days to rehabilitation is the dependent

variable and is defined as the number of day from illness/injury to

admission to an inpatient rehabilitation facility. For the purposes of these

analyses, only cases with valid onset days were included; valid onset days

are 0 to 365 days. Mean onset days were compared from pre-PPS period

(1994-2000) to the post-PPS period (2005-2012). A “wash out” period

between the two timeframes was used to allow for any crossover between

the periods. This comparison was computed across all rehabilitation

impairment groups.

Results: For all impairments combined, the mean number of onset days

post-PPS was nearly 3 days less than the average onset days pre-PPS, 14.7

versus 12.0. Analysis at the impairment group level showed similar results,

with the largest differences among pain, congenital deformity, and other

disabling impairments (19.6 vs. 10.0, 21 vs. 10.9, and 20.2 vs. 13.1,

respectively).

Conclusions: In this preliminary analysis, it is shown that the number of

days from impairment onset to admission to rehabilitation has decreased

since the implementation of PPS. Post PPS, patients are spending less time

in the acute care setting and being admitted to IRFs earlier. This has

potential implications for quality and continuity of care.

Key Words: rehabilitation, inpatients, prospective payment system

Disclosure(s): I am an employee of UDSMR, where my job

responsibilities include research on rehabilitation data from inpatient

rehabilitation facilities.

Poster 309

Understanding Medical Decision-Making for Patients with ComplexNeeds

Jay Shaw (Toronto Rehabilitation Institute), Cheryl Misak

Objective: To provide insight into medical decision-making for older

patients with complex needs.

Design: Presenting data from a case study of discharge decision-making, we

draw on insights from pragmatist epistemology to examine challenges faced

by health care practitioners when making decisions about patient care.

Setting: A ward specializing in the care of older people in a large aca-

demic hospital in London, United Kingdom.

Participants: Consultant Geriatricians (nZ2), a Clinical Fellow in Geri-

atric Medicine (nZ1), Junior Doctors/Medical Residents (nZ2), Physical

Therapists (nZ2), Occupational Therapists (nZ2), a Ward Chief Nurse

(nZ1), and Social Workers (nZ2).

Interventions: Not applicable for qualitative research (see section on

Main Outcome Measures).

Main Outcome Measure(s): The main outcomes in this study were key

qualitative themes that converged across (a) 12 qualitative interviews (1

with each practitioner) and (b) 12 weeks of daily observations of multi-

disciplinary team meetings where care decisions were made. We then

employed pragmatist inquiry-oriented epistemology to provide greater

insight into medical-decision making for patients with complex needs.

Results: The fluctuating medical condition(s), personal wishes and social

needs of older patients with complex needs create a unique context of un-

certainty that exceeds typical, quantitatively-driven models of decision-

making. We argue that this context of uncertainty demands a broader un-

derstanding of the relationships between physiology, symptoms, environ-

ment, and socio-economic influences, based on a pragmatist understanding

of the relationship between experience and inquiry. Applying this broadened

understanding of inquiry to older patients with complex needs offers the

distinct advantage of mediating between medical and social models of care.