Brock Kim A, Vale Stephen J, Cotton Susan M
Physiotherapy Department, St. Vincent's Health, Melbourne, Victoria Pde, Fitzroy, Australia.
Arch Phys Med Rehabil. 2007 Jul;88(7):827-32. doi: 10.1016/j.apmr.2007.04.001.
To compare resource use of, and outcomes for, rehabilitation for severe stroke before and after the implementation of the Casemix and Rehabilitation Funding Tree case-mix-based funding model.
Prospective, observational cohort study.
Eight inpatient rehabilitation centers in Australia.
Consecutive sample of 609 patients with severe stroke.
Not applicable.
Rehabilitation length of stay (LOS), discharge destination, and FIM instrument motor score at discharge.
The average rehabilitation LOS changed significantly between the preimplementation year and the implementation year (Mann-Whitney U, P=.001). There were no significant differences in discharge destination. FIM motor score at discharge showed significant reduction in improvement (Mann-Whitney U, P=.001) between the preimplementation year and the implementation year. There were no significant correlations between LOS in rehabilitation and gain in function for either the preimplementation year (Spearman rho, P=.07) or the implementation year (P=.15).
The change in funding model was associated with a decrease in inpatient costs and with an associated increase in disability at discharge. Our results suggest that the rate of improvement in severe stroke is variable; also, they support the use of funding models for stroke rehabilitation that allow flexibility in resource allocation.
