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EUROPEAN JOURNAL OF PHYSICAL AND REHABILITATION MEDICINE

A Journal on Physical Medicine and Rehabilitation after Pathological Events


Official Journal of the Italian Society of Physical and Rehabilitation Medicine (SIMFER), European Society of Physical and Rehabilitation Medicine (ESPRM), European Union of Medical Specialists - Physical and Rehabilitation Medicine Section (UEMS-PRM), Mediterranean Forum of Physical and Rehabilitation Medicine (MFPRM), Hellenic Society of Physical and Rehabilitation Medicine (EEFIAP)
In association with International Society of Physical and Rehabilitation Medicine (ISPRM)
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Europa Medicophysica 2000 June;35(2):67-73

language: English

Influence of the National Health Services’s new retribution system on inpatient rehabilitation for stroke

Cisari C. 1, Ricupero C. 2, Florio A. 1, Fortina G. 1, Scardigli P. 1

1 Rehabilitation Unit, ASO «Maggiore del­la Carità», Novara;
2 Rehabilitation Unit, ASL n. 11, Vercelli


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BACKGROUND: In 1995 a new ret­ri­bu­tion ­system estab­lish­ing pre­de­ter­mined ­rates per ser­vice was intro­duced in Italy. The ­reform attrib­utes an eco­nom­ic val­ue to ­each diag­no­sis (DRG) in the ­domain of ­acute med­i­cine, on the ­basis of the ­mean resourc­es ­used for the diag­no­sis and treat­ment of ­each dis­ease. In the ­domain of Rehabilitation Medicine, it reim­burs­es ­each day of inpa­tient treat­ment. The ­amount reim­bursed var­ies accord­ing to pathol­o­gy ­group (MDC). The aim of the ­paper is to eval­u­ate wheth­er ­such a system­at­ic ­approach to dis­ease has ­changed the ­work of a reha­bil­i­ta­tion ­team.
METHODS: We con­duct­ed a ret­ro­spec­tive ­study in two homo­ge­ne­ous ­groups of ­patients ­with the seque­lae of ­recent ­stroke who ­were admit­ted to a phys­i­cal med­i­cine and reha­bil­i­ta­tion ­unit (cod 56) in two ­years, ­before (1994) and ­after (1998) the ­reform. The FIM ­scale was ­used for the assess­ment of ­patients and out­comes.
RESULTS AND CONCLUSIONS: The ­study doc­u­ment­ed: a ­strong cor­re­la­tion ­between the ­total FIM ­score, ­motor func­tions and cog­ni­tive func­tion sub­scores at admis­sion and on dis­charge in 1994 and 1998, ­with con­fir­ma­tion of the ­scale’s reli­abil­ity; the ­type of ­patients admit­ted did not ­vary; the ­time ­lapse ­between ­stroke and admis­sion to reha­bil­i­ta­tion was short­er in 1998 (p<0.05); invar­i­able effi­ca­cy, effi­cien­cy of reha­bil­i­ta­tion treat­ment, and use of resourc­es; ­only in 1998: a pos­i­tive cor­re­la­tion ­between ­motor FIM ­scores at admis­sion and improve­ment on dis­charge (great­er ­gains for ­patients ­with inter­me­di­ate ­motor dis­abil­ity), a neg­a­tive cor­re­la­tion ­between ­time ­lapse ­stroke-admis­sion and ­motor improve­ment on dis­charge (­good recov­ery ­only dur­ing the ­acute ­phase).

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