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

196 Musculoskeletal & Neurological Rehabilitation KCE reports 57
8.7.6 Example: Total Hip Replacement
Prior to the introduction of the pre-paid system, patients undergoing total hip
replacement remained in the acute hospital until they could be discharged home. Due
to the increasing financial pressure on acute settings, leading to a reduction of length of
stay, referral to inpatient rehabilitation services increased significantly as functional
recovery was not established in the acute hospital. 225 , 226 Rehabilitation is offered in
various facilities: inpatient rehabilitation facilities (IRFs), Skilled Nursing Facilities (SNFs)
or long-term care hospitals (LCTH).
Currently, referrals to post-acute facilities are not regulated and there are no criteria
implemented defining patients eligible for particular services. Decision-making on
discharge disposition is made by the physician in the acute hospital. In most cases, a
discharge planner will be involved assuring a smooth transition into post-acute care
setting. Percentages of patients being discharged to one of the post-acute services vary
between 33% 227 and 58% 228 , mainly depending on the age of the studied group.
However, the specific destination is more influenced by non-clinical factors. In a recent
study by Buntin et al. 207 availability of the post-acute facility as well as the network of
the acute hospital were better predictors for discharge destination than any clinical
indicator.
As service delivery varies largely between these post-acute facilities, it is expected that
outcome will vary considerably. Recent studies showed superior outcomes for patients
admitted to IRFs in comparison to SNF-patients. 229 , 230 The hypothesis is made that this
is due to the more intensive rehabilitation programs in the IRFs. The average length of
stay varies between 10 days and 13 days mainly dependent on the need for revision
231 , 232, 233
surgery and age.
8.8 INTERNATIONAL COMPARISON
8.8.1 A basic schematic comparison of the different countries
Based on the information gathered we tried to schematically synthesise the organisation
of musculoskeletal and neurological rehabilitation for the five different countries. As can
be expected, we do not claim that these schemes cover al details and nuances. They are
made as a tool for a quick comparison, and as a stepping stone for the
recommendations in the final chapter.