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.
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.
aPhysiotherapy Department, St. Vincent’s Health, Melbourne, Victoria Pde, Fitzroy, Australia
bAllied Health and Community Programs, St. Vincent’s Health, Melbourne, Australia
cORYGEN Youth Health, Department of Psychiatry, University of Melbourne, Carlton, Australia.
Correspondence to Kim A. Brock, PhD, Physiotherapy Dept, St. Vincent’s Health, Melbourne, Victoria Pde, Fitzroy, 3065, Australia
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.
ABSTRACT