The report is available in English with a French summary - KCE

KCE reports 57 Musculoskeletal & Neurological Rehabilitation 159
aimed to communicate to the main collaborating institutions of the rehabilitation
centres 144 .
The aim of the quality approach is to develop and implement a set of 20 outcome
measures in 2009. Some further work has to be done to further develop the system for
specific patient groups. The development of the indicators is a collaborative exercise of
universities, rehabilitation physicians and research units, funded by VWS.
In the framework of the development of integrated care for stroke patients (see infra)
some particular propositions are made for 11 performance indicators for integrated
stroke care. These indicators will be used in the “benchmark reports ketenzorg-CVA”.
After an evaluation of pilot-initiatives of integrated care in stroke (edisse-study),
integrated stroke care was introduced in 23 dutch regions. For this new initiative, 19
indicators were used in order to assess the performance of the networks 151 . These
performance indicators have yet no formal endorsement as a quality instrument.
• The Dutch rehabilitation concept differentiates 4 levels of rehabilitation on
a continuum: “general and simple” “general multi-disciplinary”
“specialised and specific” and “top reference”.
• Rehabilitation is organized in acute hospital settings as well as in 24
Rehabilitation Centres throughout the country and partly in nursing
homes. Fourteen rehabilitation centres have the status of “top-reference”
centre (link with universities).
• Patients in rehabilitation institutions need an indication setting.
• The rehabilitation sector will be financed in the DBC model in 2008. Until
then the financing is based on an activity based model.
• “Function-oriented” financing for intramural health care under AWBZ is
in place for inpatient long term care-facilities. A further financing reform is
prepared including the “level of care” offered (calculated on the average
number of hours of care and treatment for a certain level of severity).
• The quality approach in rehabilitation will have to fit the DBC financing
and performance model. A “basic set” of performance indicators is being
developed and registered. “Rehabilitation treatment frameworks” are
intended as quality and accreditation instruments. They describe the set of
minimal conditions to be met when providing rehabilitation activities.
8.3.5 Example: Stroke
In recent years, a lot of “project based” attention has been paid to the organisation of
facilities for people with stroke. Different pilot initiatives have been launched to
guarantee better coordinated and integrated care between acute, post-acute, and home
care arrangements (CVA-ketenzorg). The “Commissie CVA-Revalidatie”, a working
group of the “Nederlandse Hartstichting” (www.hartstichting.nl), recommended in 2001
“stroke services” (conceptualized as integration of rehabilitation activities) as the best
way to take care of stroke patients, based on the opinion of the experts of the working
group. Apart from the networking, they advised to assure continuity of care by
transmural patient notes and/or by a transmural nurse.
The concept of stroke unit is used for a specific neurology department providing
(sub)acute treatment within the hospital. On average people stay between 10-14 days.
About 80% of the hospitals have such a stroke unit. ‘Specialised rehabilitation stroke
units’ are part of rehabilitation centres, aiming at rehabilitation for independent living.
The duration of stay can be up to six months. A ‘nursing rehabilitation stroke unit’ is a
specialised department in nursing-facilities, most of the time rehabilitating people that
are probably not returning home. There are only few units in each region. Some care
institutions for the elderly have some specific units for elderly stroke patients. As the