Post-stroke rehabilitation: an economic or medical priority? Current issues and prospects in light of new legislative regulations.
The aim of this study was to evaluate: 1) whether the reduction in duration of in-patient rehabilitation imposed by the Italian Ministry of Health's circular of 29/6/95 has been accompanied by a decline in the results achieved; and 2) whether the system of basing payments on diagnosis related group (DRG) criteria is capable of correctly evaluating differences in post-stroke clinical pictures. The study involved 461 of 497 patients consecutively admitted between 1991 and 1996 for rehabilitation after a first stroke. The average duration of hospitalisation for the period 1995-1996 was significantly shorter (p<0.001) than that of the previous years; at the same time, there was a significant increase (p<0.05) in the number of poor responders in both neurological and functional (mobility) terms. Furthermore, the early discharge after 60 days of the 1995-1996 patients compromised the stabilisation of recovery and led to a subsequent functional decline. It is therefore hoped that the current regulations will be revised and that payments based on a functional related group (FRG) criterion will be introduced.
I.R.C.C.S. S. Lucia, University Tor Vergata, Roma, Italy.
S
S
Paolucci
M
M
Traballesi
L
L
Emberti Gialloreti
L
L
Pratesi
S
S
Lubich
A
A
Salvia
M G
MG
Grasso
D
D
Morelli
M
M
Pulcini
E
E
Troisi
P
P
Coiro
C
C
Caltagirone
D000368:Aged; D003953:Diagnosis-Related Groups / Q000191:economics / Q000331:legislation & jurisprudence; D005260:Female; D006292:Health Priorities; D006760:Hospitalization / Q000191:economics / Q000331:legislation & jurisprudence; D006801:Humans; D007558:Italy; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D017063:Outcome Assessment, Health Care; D020127:Recovery of Function; D012046:Rehabilitation / Q000191:economics* / Q000331:legislation & jurisprudence*; D020521:Stroke / Q000191:economics* / Q000628:therapy; D000071939:Stroke Rehabilitation; D016896:Treatment Outcome