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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 2001 September;37(3):129-34

language: English

The Ital­ian ­research pro­ject ­for ­the pros­pec­tive pay­ment of hos­pi­tal reha­bil­i­ta­tion ­care. Notes on a ­work in ­progress

Saitto C., De Bernardini L. 1, Fletzer D. A. 2, Giustini A. 3, Littera A. M. 4, Mastrilli F. 5, Mastrobuono I. 3, Traballesi M. 5, Di Benedetto P. 6

From ­the Dipartimento di Epidemiologia ­RME - Roma
1 Villa ­delle Quercie-Poligest - Roma
2 ­ASL ­RMD - Roma Centro Paraplegici - Ostia
3 Tosinvest Sanità - Roma
4 Agenzia di Sanità Pubblica - Roma
5 Fondazione ­IRCCS S. Lucia - Roma
6 Azienda «Ospedali Riuniti» - Trieste


Prospective pay­ment of inpa­tient reha­bil­i­ta­tion ser­vic­es ­has ­been sug­gest­ed or imple­ment­ed in sev­er­al coun­tries. The cur­rent Italian ­system clas­si­fies ­patients ­into 5 ­broad ­groups ­based on MDCs. MDCs ­are ­the par­ent par­ti­tion of ­the ­DRG clas­sifi­ca­tion ­and ­are mean­ing­less in ­the reha­bil­i­ta­tion set­ting, a spe­cif­ic clas­sifi­ca­tion of inpa­tient reha­bil­i­ta­tion ­care is ­thus obvi­ous­ly need­ed. The fun­da­men­tal ­goal of an ­iso-­resource clas­sifi­ca­tion is build­ing clin­i­cal­ly homo­ge­ne­ous dis­charge ­groups ­with ­the small­est pos­sible with­in-­the-­group ­resource con­sump­tion var­i­abil­ity. Existing mod­els of ­patient assess­ment ­and clas­sifi­ca­tion ­are pre­sent­ed ­and ­their ­strengths ­and short­com­ings ­are dis­cussed. The ­basic char­ac­ter­is­tics of a sat­is­fac­to­ry mod­el ­are ­defined ­and meth­ods of mod­el build­ing ­are brief­ly ­described. No assess­ment ­tool ­looks com­plete­ly sat­is­fac­to­ry, ­but to ­accept a lim­it­ed ­set of infor­ma­tion ­means accept­ing ­the var­i­able selec­tion ­and ­the asso­ci­a­tion meth­ods of exist­ing clas­sifi­ca­tions. The selec­tion of var­i­ables ­and ­the attri­bu­tion of var­i­able ­weights in ­the clas­sifi­ca­tion ­system ­must be a ver­i­fi­able ­end ­point ­and ­not ­the start­ing ­point of anal­y­sis. A rela­tion­ship ­between explan­a­to­ry var­i­ables ­and out­come ­must be ­sought, ­not ­only as a ­tool to orga­nize ­and ­group ­the ­costs of ­the ­observed ­events, ­like ­CART, ­but ­also as an instru­ment to fore­see ­the rea­son­able ­costs of ­the ­events to ­come. Several group­ing meth­ods ­must ­then be test­ed ­and com­pared ­against ­CART (Correlation And Regression Trees), ­like Search Partition Analysis (­SPAN), ­main com­po­nents anal­y­sis, clus­ter anal­y­sis, mul­ti­var­i­ate anal­y­sis. The objec­tives of ­our ­research ­are a man­age­able assess­ment ­tool ­where ­only pos­i­tive­ly test­ed infor­ma­tion ­will be ­retained ­and a clas­sifi­ca­tion ­system ­which ­could be con­sid­ered an intel­li­gible ­and equi­ta­ble “­iso-­resource” clas­sifi­ca­tion ­system.

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