title: Changes in stroke rehabilitation outcomes after the implementation of Japan's long-term care insurance system: a hospital-based study.
abstract: OBJECTIVE
  To explore the changes in stroke rehabilitation outcomes after the introduction of Japan's long-term care insurance (LTCI) system.
  
  
  METHODS
  Stroke patients discharged during a 3-yr period before and after the implementation of LTCI were compared (before-LTCI vs. after-LTCI). Outcome measures included onset to admission interval, length of stay, and correlation between discharge site and functional level at discharge.
  
  
  RESULTS
  A total of 201 patients in the before-LTCI group and 252 patients in the after-LTCI group were eligible for the study. Shorter mean length of stay (P < 0.01) and higher rates of discharge to a rehabilitation facility (P < 0.01) were found in the after-LTCI group. Logistic regression analysis revealed that the patients with higher activities of daily living scores or ambulatory status at discharge were more likely to be discharged to home after inpatient rehabilitation in both groups (P < 0.01). The rate of discharge to home was similar in both groups.
  
  
  CONCLUSIONS
  Within this rehabilitation hospital's experience, the mean length of stay was reduced after the implementation of the LTCI. Although it was one of the primary goals of the LTCI, the rate of discharge to home did not significantly increase. Further evaluation and modification of the LTCI and more efforts to improve a patient's activities of daily living and ambulatory status at discharge will be necessary to promote in-home care in Japan.
authors: Division of Physical Medicine and Rehabilitation, Stanford University School of Medicine, Stanford, California, USA.
authors: Yasushi
authors: Y
authors: Miyoshi
authors: Jeffrey K
authors: JK
authors: Teraoka
authors: Elaine S
authors: ES
authors: Date
authors: Mi Jung
authors: MJ
authors: Kim
authors: Rosalyn T
authors: RT
authors: Nguyen
authors: Seido
authors: S
authors: Miyoshi
mesh_terms: D000203:Activities of Daily Living; D000368:Aged; D005260:Female; D006801:Humans; D007353:Insurance, Long-Term Care; D007564:Japan; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D017063:Outcome Assessment, Health Care; D010351:Patient Discharge / Q000706:statistics & numerical data; D012047:Rehabilitation Centers / Q000191:economics / Q000706:statistics & numerical data*; D020521:Stroke / Q000191:economics; D000071939:Stroke Rehabilitation