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

182 Musculoskeletal & Neurological Rehabilitation KCE reports 57
the development of Quality Indicators. Quality indicators will be used to assess and
compare the results of treatment and care, and for reviewing operations. Quality
indicators should give all stakeholder insight into health care practice.
The model is similar to that used in Dutch health care systems, and very much related
to performance indicators.
However, the Swedish quality pilot projects pay a lot of attention to the needs at
population, group an individual levels. A lot of attention is now going into the
development of a registration, in which individual needs are assessed through scales or
rating systems.
In rehabilitation issues, the future assessment will focus on functionality and will be
compared to identified targets set in different stages. The electronic registration system
of needs and targets, aims at providing documentation for decision-making on treatment
and care, for reviewing and studying outcomes and as such as a quality tool at various
levels (individual, operational, regional and national levels).
• In Sweden, the organizational model of rehabilitation takes into account
the level of specialisation and the needs of the population to provide
rehabilitation care.
• Related to the important role of primary care, it is sometimes difficult to
make a clear delimitation between rehabilitation in the health system
(counties) and maintenance training and prevention of loss of function in
the social system.
• Rehabilitation facilities cover the range from acute hospital facilities, over
specialised units within the hospitals, inpatient and outpatient hospital
services and specialised rehabilitation centres to long term care facilities.
• General regulations for health care emphasize on monitoring and qualityimprovement
measures focusing on technical quality and safety, and issues
related to the people for whom health services are intended. National
Quality Registers are used as supportive tools for analyses of the medical
quality and outcomes in specific parts of the healthcare system. Reflections
started on developing a model of quality indicators for the health care
sector.
8.6.4 Example: Lower Extremity Amputation
According to the Swedish National Board of Health and Welfare (SNBHW), more than
3000 patients undergo amputation annually in Sweden. The amputation rate increases
with age, and most amputations are performed on patients over 60. After the operation
some follow-up treatment, and some extensive rehabilitation and nursing care has to be
organised. Sweden has no standard approach for this rehabilitation after LEA.
Rehabilitation for LEA is offered in regional and University rehabilitation units. In
general it are only those people for which prostheses are matched, that are referred to
rehabilitation centres. Most of the (especially older) groups remain short time at the
rehabilitation unit of the hospital, before returning home.
An older study 192 retrospectively scrutinized medical records of patients underwent
major lower limb amputation during 1980-82 were. The records showed 131
amputations were performed in 106 patients at the district hospital and 22 amputations
on 17 patients at the local university hospital, referral centre, altogether 57 men and 66
women. Of the amputees 47 per cent were older than 80 years. Final amputation level
was above-knee in 61 per cent of the patients treated at the district hospital. For
patients who came from and eventually returned to their own homes the mean hospital
stay amounted to 184 days (postoperative deaths excluded). After amputation 26
patients were trained to wear a prosthesis and 16 of these used the prosthesis 2 years
after amputation..
A more recent prospective study 193 described the overall treatment and outcome of
patients who underwent major LEA. The study took place over a five year period in the