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EUROPEAN JOURNAL OF PHYSICAL AND REHABILITATION MEDICINE
Rivista di Medicina Fisica e Riabilitativa dopo Eventi Patologici
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Indexed/Abstracted in: CINAHL, Current Contents/Clinical Medicine, EMBASE, PubMed/MEDLINE, Science Citation Index Expanded (SciSearch), Scopus
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Europa Medicophysica 2000 Giugno;35(2):67-73
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
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).