The Australian National Sub-acute and Non-acute Patient Casemix Classification (AN-SNAP): its application and value in a stroke rehabilitation programme.
OBJECTIVE
To investigate whether the Australian National Sub-acute and Non-acute Patient Casemix Classification (SNAP) and Functional Independence Measure and Functional Related Group (Version 2) (FIM-FRG2) casemix systems can be used to predict functional outcome, and reduce the variance of length of stay (LOS) of patients undergoing rehabilitation after strokes.


METHODS
The study comprised a retrospective analysis of the records of patients admitted to the Cedar Court Healthsouth Rehabilitation Hospital for rehabilitation after stroke.


METHODS
The sample included 547 patients (83.3% of those admitted with stroke during this period). Patient data were stratified for analysis into the five SNAP or nine FIM-FRG2 groups, on the basis of the admission FIM scores and age.


RESULTS
The AN-SNAP classification accounted for a 30.7% reduction of the variance of LOS, and 44.2% of motor FIM, and the FIM-FRG2 accounts for 33.5% and 56.4% reduction respectively. Comparison of the Cedar Court with the national AN-SNAP data showed differences in the LOS and functional outcomes of older, severely disabled patients. Intensive rehabilitation in selected patients of this type appears to have positive effects, albeit with a slightly longer period of inpatient rehabilitation.


CONCLUSIONS
Casemix classifications can be powerful management tools. Although FIM-FRG2 accounts for more reduction in variance than SNAP, division into nine groups meant that some contained few subjects. This paper supports the introduction of AN-SNAP as the standard casemix tool for rehabilitation in Australia, which will hopefully lead to rational, adequate funding of the rehabilitation phase of care.
Lowthian
P
P
Victorian Rehabilitation Research Institute, Cedar Court Healthsouth Rehabilitation Hospital & University of Melbourne, Australia.
Disler
P
P
Ma
S
S
Eagar
K
K
Green
J
J
de Graaff
S
S
D000203:Activities of Daily Living / Q000145:classification; D000368:Aged; D001315:Australia; D003071:Cognition / Q000145:classification; D017050:Episode of Care; D005380:Financing, Government; D006801:Humans; D007902:Length of Stay; D017063:Outcome Assessment, Health Care; D010343:Patient Admission; D020127:Recovery of Function; D012046:Rehabilitation / Q000145:classification; D012047:Rehabilitation Centers / Q000191:economics / Q000706:statistics & numerical data*; D012720:Severity of Illness Index; D020521:Stroke / Q000145:classification*; D000071939:Stroke Rehabilitation; D019467:Subacute Care / Q000191:economics