Aging, Rehabilitation and Geriatric Care Program, Lawson Health Research Institute, Parkwood Hospital Site, London, Ontario, Canada.
Int J Stroke. 2013 Aug;8(6):430-5. doi: 10.1111/j.1747-4949.2011.00748.x. Epub 2012 Feb 15.
The superiority of dedicated stroke rehabilitation over generalized rehabilitation services has been suggested by the literature; however, these models of service delivery have not been evaluated in terms of their relative effectiveness in situ.
A comparison of the process indicators associated with these two models of service provision was undertaken within the Ontario healthcare system.
All adults admitted with a diagnosis of stroke for inpatient rehabilitation in Ontario, Canada during the years 2006-2008 were identified from the National Rehabilitation Reporting System database. Each of the admitting institutions was classified as providing rehabilitation services on either a stroke dedicated or nondedicated unit. A dedicated unit was identified by the presence of a collection of geographically distinct, stroke-dedicated beds and dedicated therapists. Selected process indicators from the National Rehabilitation Reporting System database were compared between the two facility types.
Sixty-seven facilities provided stroke rehabilitation services to 6709 adult stroke patients during the years 2006-2008. Of the total number of patients who entered inpatient rehabilitation, 1725 (25·7%) received care in eight facilities that met basic criteria for a dedicated stroke rehabilitation unit. On average, these patients took significantly longer to arrive for inpatient rehabilitation (37·2 ± 155·5 vs. 22·8 ± 95·0 days, P < 0·001), were admitted with higher Functional Independence Measure scores (77·5 ± 22·5 vs. 74·8 ± 24·5, P < 0·001), had significantly longer lengths of stay (42·1 ± 25·9 vs. 35·4 ± 27·2 days, P < 0·001), and demonstrated significantly lower Functional Independence Measure efficiency scores (0·62 ± 0·47 vs. 0·88 ± 1·03, P > 0·001) compared with patients who were admitted to nondedicated units. The proportion of patients admitted to a dedicated unit and subsequently discharged home was similar to that of patients discharged from nondedicated units (70·5% vs. 68·8%, P = 0·206).
In Ontario, patients admitted to dedicated stroke rehabilitation units fared no better on commonly-used process metrics compared with patients admitted to nondedicated rehabilitation units.
文献表明，专门的中风康复治疗比一般的康复服务更具优势；然而，这些服务提供模式尚未在实际情况下评估其相对有效性。
在安大略省的医疗保健系统中，对这两种服务提供模式相关的过程指标进行比较。
从国家康复报告系统数据库中确定了 2006-2008 年期间在加拿大安大略省因住院康复而住院的所有成年中风患者。每个收治机构都被归类为在专门的中风病房或非专门病房提供康复服务。专门病房的特征是有一组地理位置不同的专门的中风病床和专门的治疗师。从国家康复报告系统数据库中选择了一些过程指标，在两种设施类型之间进行比较。
在 2006-2008 年期间，有 67 家机构为 6709 名成年中风患者提供了中风康复服务。在进入住院康复的总患者人数中，有 1725 名（25.7%）在符合专门中风康复病房基本标准的 8 家机构中接受了治疗。平均而言，这些患者接受住院康复的时间明显更长（37.2±155.5 天与 22.8±95.0 天，P<0.001），入院时的功能独立性测量评分更高（77.5±22.5 分与 74.8±24.5 分，P<0.001），住院时间明显更长（42.1±25.9 天与 35.4±27.2 天，P<0.001），功能独立性测量效率评分明显较低（0.62±0.47 与 0.88±1.03，P>0.001）与入住非专门病房的患者相比。入住专门病房并随后出院回家的患者比例与从非专门病房出院的患者比例相似（70.5%与 68.8%，P=0.206）。
在安大略省，与入住非专门康复病房的患者相比，入住专门中风康复病房的患者在常用的过程指标上并没有表现得更好。
