Vitacca Michele, Paneroni Mara, Ambrosino Nicolino
Respiratory Rehabilitation Unit, Istituti Clinici Scientifici Maugeri IRCCS, Institute of Lumezzane (BS).
Respiratory Rehabilitation Unit, Istituti Clinici Scientifici Maugeri IRCCS, Institute of Montescano (PV), Italy.
Multidiscip Respir Med. 2023 Nov 30;18(1):936. doi: 10.4081/mrm.2023.936. eCollection 2023 Jan 17.
The use of case-based reimbursement for medical rehabilitation is greatly discussed. The investigators explored the relationship between disability and reimbursement opportunities in individuals with respiratory diseases undergoing in-hospital pulmonary rehabilitation (PR), considering the correlation (if any) between the Rehabilitation Complexity Scale (RCS-E v13) scores used at admission and the actual reimbursement.
This study is part of a larger prospective multicenter study conducted by eight Pulmonary Rehabilitation Units in Italy. Here, investigators considered only data from the Lombardy Region. On January 30 or February 28, 2023, participants were allocated according to the main DRG into 4 groups [tracheostomized/ventilated (TX/V), chronic respiratory failure (CRF), COPD, and miscellaneous group]. We recorded anthropometrics, diagnosis, international outcome measures, and calculated admission and discharge RCS-E v13 scores and hospital stay reimbursement according to the healthcare system (HS).
Three hundred and sixteen participants were evaluated. Patients were elderly, in the majority of cases with CRF, presenting comorbidities, disability, dyspnea, and reduced effort tolerance. At admission, RCS-E v13 showed an average moderate value of complexity. The median (IQR) HS reimbursement/stay was different among groups. RCSE v13 evaluated at admission was weakly (r=0.3471), but significantly related to the HS reimbursement/stay (p<0.0001) mainly due to TX/V and miscellaneous subgroups, while no relationship was found for COPD and CRF patients. After PR, all outcome measures improved significantly in all groups (p<0.001 for all). Higher RCS-E v13 scores at admission did not correspond to a proper amount of reimbursement, being this latter under- or over-estimated if compared to needs assessed by RCS-E v13. RCS-E v13 at discharge decreased for all subgroups (range from -6 to -11) reaching a low value of complexity.
The RCS-E v13 disability score does not fully mirror the HS reimbursement for patients undergoing inhospital PR.
基于病例的医疗康复报销方式备受讨论。研究人员探讨了住院接受肺部康复（PR）的呼吸系统疾病患者的残疾状况与报销机会之间的关系，同时考虑入院时使用的康复复杂程度量表（RCS-E v13）评分与实际报销之间的相关性（如有）。
本研究是意大利八个肺部康复单位开展的一项更大规模前瞻性多中心研究的一部分。在此，研究人员仅考虑来自伦巴第地区的数据。2023年1月30日或2月28日，参与者根据主要诊断相关分组（DRG）被分为4组[气管切开/通气（TX/V）、慢性呼吸衰竭（CRF）、慢性阻塞性肺疾病（COPD）和其他组]。我们记录了人体测量学数据、诊断结果、国际预后指标，并根据医疗保健系统（HS）计算了入院和出院时的RCS-E v13评分以及住院期间的报销金额。
共评估了316名参与者。患者年龄较大，大多数患有CRF，伴有合并症、残疾、呼吸困难且运动耐力下降。入院时，RCS-E v13显示出平均中等程度的复杂程度。各组之间HS报销/住院的中位数（四分位间距）有所不同。入院时评估的RCSE v13与HS报销/住院呈弱相关（r = 0.3471），但具有显著相关性（p < 0.0001），主要归因于TX/V组和其他亚组，而COPD和CRF患者未发现相关性。PR后，所有组的所有预后指标均显著改善（所有p < 0.001）。入院时较高的RCS-E v13评分并不对应适当的报销金额，与RCS-E v13评估的需求相比，报销金额被低估或高估。所有亚组出院时的RCS-E v13均下降（范围为-6至-11），达到较低的复杂程度值。
RCS-E v13残疾评分不能完全反映住院接受PR患者的HS报销情况。
