• Am J Manag Care · Jul 2020

    Observational Study

    The development of a patient-reported functional limitations index.

    • Megan Mathews, Denis Agniel, Marc N Elliott, Steven C Martino, Paul Guerino, Nate Orr, Judy H Ng, and Megan K Beckett.
    • RAND Corporation, 1776 Main St, Santa Monica, CA 90401. Email: Elliott@rand.org.
    • Am J Manag Care. 2020 Jul 1; 26 (7): e225-e231.

    ObjectivesTo develop an easy-to-interpret, patient-reported Functional Limitations Index (FLI) that can be used to assess and monitor the full spectrum of functioning in a community-dwelling population.Study DesignObservational design using nationally representative survey data.MethodsWe used self-rated health as a criterion for empirically assigning weights to 5 National Health Interview Survey items assessing difficulty with seeing, hearing, walking, cognition, and self-care. In addition to succinctly summarizing cumulative limitations, we addressed 2 main questions: (1) Which limitations have stronger associations with self-rated health? and (2) How does severity (from 0, no difficulty, to 3, unable to do) relate to self-rated health? We generated a respondent-level summary score based on a model predicting self-rated health from the 5 linearly scored (0-3) items and used splines to account for nonlinear severity-self-rated health associations.ResultsThe strongest association of specific functional limitations with self-rated health involved mobility; the weakest associations involved sensory limitations. The association of severity with self-rated health was nonlinear and largest moving from no difficulty to somewhat difficult. Nationally, 5% of noninstitutionalized adults were considered most limited, 8% somewhat limited, and 87% least limited. Great mobility limitations (defined as a lot of difficulty or unable to do) most distinguished limitation groups (present in 0% of least limited, 25% of somewhat limited, and 70% of most limited).ConclusionsThe FLI is an easy-to-administer, easy-to-interpret, and valid summary measure of disability that health plans and health care organizations can use for quality-of-care monitoring across a variety of settings to improve care for patients with disabilities.

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