ORIGINAL ARTICLES   Free access

Europa Medicophysica 2000 June;35(2):67-73

Copyright © 2000 EDIZIONI MINERVA MEDICA

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

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).