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.


METHODS
Prospective, observational cohort study.


METHODS
Eight inpatient rehabilitation centers in Australia.


METHODS
Consecutive sample of 609 patients with severe stroke.


METHODS
Not applicable.


METHODS
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 rho, 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.
Brock
Kim A
KA
Physiotherapy Department, St. Vincent's Health, Melbourne, Victoria Pde, Fitzroy, Australia. Kim.Brock@svhm.org.au
Vale
Stephen J
SJ
Cotton
Susan M
SM
D000368:Aged; D001315:Australia; D003953:Diagnosis-Related Groups; D004185:Disability Evaluation; D005260:Female; D006801:Humans; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D018803:Models, Economic; D017063:Outcome Assessment, Health Care; D010351:Patient Discharge; D011446:Prospective Studies; D012047:Rehabilitation Centers / Q000191:economics; D012720:Severity of Illness Index; D020521:Stroke / Q000191:economics*; D000071939:Stroke Rehabilitation