In patient stroke rehabilitation efficiency: influence of organization of service delivery and staff numbers.
BACKGROUND
Outcomes of inpatient stroke rehabilitation need to be reviewed in terms of optimal resource utilization (staff time, service organization, and duration of stay). We compared FIM efficiency scores between three hospitals, and also variation in FIM scores over a ten year period in one hospital undergoing reduction in staff numbers, to examine the relationship between outcome and service characteristics.


METHODS
This is a retrospective study comparing the mean FIM efficiency for stroke patients (FIM score - FIM admission score) divided by duration of stay for 2005 among three rehabilitation hospitals adjusting for age and baseline FIM score, and a longitudinal study of changes in mean FIM efficiency during a ten year period in one hospital, to examine the effects of different service organization and staff numbers.


RESULTS
FIM efficiency (FIMEG) was inversely associated with age, and positively associated with admission FIM score. FIMEG was higher in the hospital with a coordinated care plan involving medical, nursing, occupational, physiotherapy staff and other healthcare providers working as a team, with a seamless interface with community rehabilitation services. Over a ten year period, reduction in staff numbers was associated with reduction in FIMEG, which may be offset to some extent by service re-engineering.


CONCLUSIONS
Within hospital organization of stroke rehabilitation services may influence outcome. A critical number of staff may be identified for the provision of services, below which rehabilitation efficiency may be affected.
Woo
Jean
J
Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Shatin, NT, Hong Kong SAR, China. jeanwoowong@cuhk.edu.hk
Chan
Shiu Yu
SY
Sum
Mi Wan Cecilia
MW
Wong
Eric
E
Chui
Yeuk Ping Maria
YP
D000203:Activities of Daily Living; D017598:Efficiency, Organizational; D005260:Female; D006739:Hospital Administration; D006801:Humans; D008297:Male; D009788:Occupational Therapy; D010564:Personnel, Hospital / Q000600:supply & distribution; D020127:Recovery of Function; D012189:Retrospective Studies; D012720:Severity of Illness Index; D000071939:Stroke Rehabilitation; D016896:Treatment Outcome; D000078329:Workforce