Archives of Physical Medicine and Rehabilitation
Volume 88, Issue 7 , Pages 827-832, July 2007

The Effect of the Introduction of a Case-Mix−Based Funding Model of Rehabilitation for Severe Stroke: An Australian Experience

Presented to the Joint Conference of the National Neurology and Gerontology Groups of the Australian Physiotherapy Association, November 17, 2005, Melbourne, Australia, and the 14th Annual Scientific Meeting of the Australasian Faculty of Rehabilitation Medicine, May 4, 2006, Cairns, Australia.

  • Kim A. Brock, PhD

      Affiliations

    • Physiotherapy Department, St. Vincent’s Health, Melbourne, Victoria Pde, Fitzroy, Australia
    • Corresponding Author InformationCorrespondence to Kim A. Brock, PhD, Physiotherapy Dept, St. Vincent’s Health, Melbourne, Victoria Pde, Fitzroy, 3065, Australia
    • ,
  • Stephen J. Vale, MPhysio, MBus

      Affiliations

    • Allied Health and Community Programs, St. Vincent’s Health, Melbourne, Australia
    • ,
  • Susan M. Cotton, PhD

      Affiliations

    • ORYGEN Youth Health, Department of Psychiatry, University of Melbourne, Carlton, Australia.

Abstract 

Brock KA, Vale SJ, Cotton SM. The effect of the introduction of a case-mix–based funding model of rehabilitation for severe stroke: an Australian experience.

Objective

To compare resource use of, and outcomes for, rehabilitation for severe stroke before and after the implementation of the Casemix and Rehabilitation Funding Tree case-mix−based funding model.

Design

Prospective, observational cohort study.

Setting

Eight inpatient rehabilitation centers in Australia.

Participants

Consecutive sample of 609 patients with severe stroke.

Interventions

Not applicable.

Main Outcome Measures

Rehabilitation length of stay (LOS), discharge destination, and FIM instrument motor score at discharge.

Results

The average rehabilitation LOS changed significantly between the preimplementation year and the implementation year (Mann-Whitney U, P=.001). There were no significant differences in discharge destination. FIM motor score at discharge showed significant reduction in improvement (Mann-Whitney U, P=.001) between the preimplementation year and the implementation year. There were no significant correlations between LOS in rehabilitation and gain in function for either the preimplementation year (Spearman ρ, P=.07) or the implementation year (P=.15).

Conclusions

The change in funding model was associated with a decrease in inpatient costs and with an associated increase in disability at discharge. Our results suggest that the rate of improvement in severe stroke is variable; also, they support the use of funding models for stroke rehabilitation that allow flexibility in resource allocation.

Key Words: Rehabilitation, Stroke, Treatment outcome

 

 No commercial party having a direct financial interest in the results of the research supporting this article has or will confer a benefit upon the author(s) or upon any organization with which the author(s) is/are associated.Reprints are not available from the author.

PII: S0003-9993(07)00289-4

doi:10.1016/j.apmr.2007.04.001

Archives of Physical Medicine and Rehabilitation
Volume 88, Issue 7 , Pages 827-832, July 2007

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