title: Results of new policies for inpatient rehabilitation coverage in Japan.
abstract: BACKGROUND
  A new interdisciplinary postacute rehabilitation unit, the Kaifukuki (convalescent) rehabilitation ward (KRW), has been incorporated into the Japanese medical insurance system since 2000. More than 57 000 beds (45 beds per 100 000 population) are currently available nationwide. The maximal coverage for therapy sessions increased from 2 to 3 hours per day, 7 days a week, in 2006.
  
  
  OBJECTIVE
  To investigate how changes in policy affected rehabilitation outcomes of KRWs in a retrospective cohort study of 87 917 patients over 10 years.
  
  
  RESULTS
  The mean (standard deviation) age of the patients was 73.0 (13.8) years, and 55.4% were women. Diagnoses included stroke (47.9%); orthopedic diseases, including hip fracture (35.2%); and traumatic brain and spinal cord injury (5.4 %). Onset-admission interval (OAI) was 31.5 (18.6) days, length of stay was 75.9 (46.1) days, and 69.1% were discharged home. Daily therapy time was 79.4 (34.5) minutes. Admission/discharge scores of the Barthel Index and the Functional Independence Measure were 49.3 (31.0)/70.4 (31.9) and 75.3 (31.2)/91.7 (31.8), respectively. Year-by-year comparison revealed that older age, greater initial disability, and shorter OAI were coupled with a higher dose of rehabilitative interventions and a higher rate of home discharge. Longitudinal data from a cohort of hospitals implied a small but significant dose-dependent effect of hours of therapy on rehabilitation outcome after stroke.
  
  
  CONCLUSIONS
  Although the organization of KRWs is in flux as the system of hospitals grows, results over the past 8 years suggest that changes in national insurance policies are affecting the quantity and organization of rehabilitation interventions and improvement in patient outcomes.
authors: Annual Survey Committee, Kaifukuki Rehabilitation Ward Association, Tokyo, Japan. webeo@ga2.so-net.ne.jp
authors: Ichiro
authors: I
authors: Miyai
authors: Shigeru
authors: S
authors: Sonoda
authors: Shota
authors: S
authors: Nagai
authors: Yuko
authors: Y
authors: Takayama
authors: Yukiko
authors: Y
authors: Inoue
authors: Atsuo
authors: A
authors: Kakehi
authors: Masaki
authors: M
authors: Kurihara
authors: Makoto
authors: M
authors: Ishikawa
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D015331:Cohort Studies; D005260:Female; D050723:Fractures, Bone / Q000453:epidemiology / Q000534:rehabilitation*; D006801:Humans; D007564:Japan / Q000453:epidemiology; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D009313:National Health Programs / Q000331:legislation & jurisprudence / Q000639:trends*; D009422:Nervous System Diseases / Q000453:epidemiology / Q000534:rehabilitation*; D017063:Outcome Assessment, Health Care / Q000379:methods*; D012047:Rehabilitation Centers / Q000191:economics / Q000639:trends*; D012189:Retrospective Studies