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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.
KCE reports 57 Musculoskeletal & Neurological Rehabilitation 197 8.8.1.1 The Netherlands 8.8.1.2 France acute Post acute Chronic Rehabiliation physician Topreference (academic) Specialised, pathology specific, multidisciplinary General, multidisciplinary policlinics General, monodisciplinary Rehabiliation physician Specialised, multidisciplinar selective pathologies (interregional) Specialised, multidisciplinary (regional) General, multidisciplinary (intermediate-local) General, monodisciplinary Rehab centres Rehab centres Nursing homes Hospital units Home rehab Acute Post acute Chronic Rehab centres Rehab centres Office indication setting Hospital units Nursing homes Hôpital a domicile Home rehab
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Dépôt légal : D/2007/10.273/19
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35. Etude relative aux coûts poten
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