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

More documents

Recommendations

Info

212 Musculoskeletal & Neurological Rehabilitation KCE reports 57 rehabilitation. However, some of these might be competitive as a specific or even highly specific organisation. Clear requirements have to be set at the specific and highly specific levels on expected performances and on human resources, infrastructure and equipment. Patient target groups need to be redefined in order to avoid overlap. The number of specific and highly specific organisations needs to be based on epidemiologic and geographical data. Follow up through systematic central registration will be necessary in order to avoid eventual under- or oversupply. 9.2.2 A Patient Classification System (PCS) to support the referral process The conceptual stratified rehabilitation model should be supported by a patient classification system. Criteria related to diagnosis, required intensity of care, rehabilitation needs and goals as well as personal and environmental factors, are needed to refer patients to a certain type of organisation in a stratified rehabilitation network (see chapter 3). Ideally one should strive for a PCS supporting patient referral (clinical decision making) as well as resource allocation and quality assessment 100 (see chapter 3). • One common tool for both purposes makes it easier to respect the desired interaction between the resource allocation process and the rehabilitation services; • Only one registration is required; • Technical and financial efforts will result in benefits on both domains. Figure 9.9: Principles of an ideal Patient Classification System (for detailed information on this figure see chapter 3) Patient Classification System Outcome measures Outcome model Rehabilitation Budget Quality system Patient classification system Managerial level Clinical level Rehabilitation Services The comments of consulted international experts (chapter 3) illustrate both the potential value of such a PCS but also the doubts on the compatibility of both goals (clinical and managerial) when looking at the existing scales. Some observations on existing PCS: • ICF can serve in the mapping of the results of technical, clinical and health-status measurement tools. However, the scope of ICF is much broader than the areas relevant for clinical use, and it does not assist the clinician in selecting the most salient aspects of functioning to
KCE reports 57 Musculoskeletal & Neurological Rehabilitation 213 assess, or the specific instruments to use in that assessment for a given individual. The ICF Core Sets are expected to offer a solution for this problem but problems are still remaining 234, 96, 235, 236, 117 . Moreover, ICF does not meet a number of basic requirements for scientific classification due to a lack of a clear definition for all the components. It is not clear yet how researchers will handle this obstacle. ICF can currently be used as a conceptual framework but the operational application of ICF is still experimental. • Most other patient classification systems that were found only support resource allocation (see infra). The PCS currently used for resource allocation in some countries (For example: IRF- PAI, AN-SNAP, CRAFT) were extensively discussed in chapter 3. They typically include 3 parts: • medical diagnosis (impairment category) • estimation of functional disability • registration of additional factors that typically influence the rehabilitation process like co-morbidities, age or social factors. FIM-FRG (developed in the USA; led to IRF-PAI, AN-SNAP and to some principles in the German classification system etc.) uses FIM to estimate functional disability for inpatient post-acute rehabilitation and explains 30 % of variance of costs within the American Inpatient rehabilitation system 23, 22 . Although only covering some aspects of ICF, this is a first step in predicting and controlling resource allocation for in-hospital post-acute rehabilitation. As additional factors in this system, impairment codes, age and co-morbidities are used. The already existing PCS for managerial purposes have some disadvantages. Some PCS like IRF-PAI are only applicable for inpatient or for outpatient rehabilitation and do not cover the whole continuum of rehabilitation care. AN-SNAP (developed in Australia based on FIM-FRG) is an exception (see chapter 3); moreover it is specifically developed for smaller countries in order to avoid that some PCS-classes contain only few patients. PCS for hospitalised patients include the results of tools which measure level of independence concerning ADL (FIM). These results are rather an indicator for burden of general nursing care and do not indicate rehabilitation needs. Patient groups within these PCS are homogeneous for resource needs during a hospital stay (e.g. Length Of Stay (LOS)) but not for resource needs for rehabilitation. During the development of FIM-FRG (and subsequently IRF-PAI and AN-SNAP), these “mistakes” were made voluntarily, because no other measurement tool except FIM had been sufficiently validated for almost all diagnostic categories in rehabilitation care (which is necessary for financial purposes). The option to use LOS (and not therapy intensity) as an indicator for resource allocation was taken because regarding therapy needs, practices and opinions among rehabilitation specialists are divergent (as we also demonstrated in chapter 6 and 7) and evidence in the literature is still scarce 23, 22 . The countries currently using these PCS systems are aware of the difficulties mentioned, and research is going on to develop a managerial system based on ICF. Moreover, efforts are made to make sure that this new system will fit with the financing systems already in use. These PCS are often expensive tools and require investments in software applications and probably also in hardware. Even an existing PCS should first be validated in the Belgian context and no Belgian data are available till now. As already outlined in chapter 4, the validation of a PCS available in other countries could go hand in hand with a validating exercise of the existing Belgian registration system MVG-RIM2, which also includes some measures of level of independence concerning ADL, for inpatient rehabilitation managerial purposes.
Page 1 and 2:
Organisation et Financement de la R
Page 3 and 4:
Organisation et financement de la r
Page 5 and 6:
KCE Reports 57B Réadaptation locom
Page 7 and 8:
Page 9 and 10:
Page 11 and 12:
Page 13 and 14:
Page 15 and 16:
KCE Reports 57 Musculoskeletal & Ne
Page 17 and 18:
Page 19 and 20:
Page 21 and 22:
KCE reports 57 Musculoskeletal & Ne
Page 23 and 24:
Page 25 and 26:
Page 27 and 28:
Page 29 and 30:
Page 31 and 32:
Page 33 and 34:
Page 35 and 36:
Page 37 and 38:
Page 39 and 40:
Page 41 and 42:
Page 43 and 44:
Page 45 and 46:
Page 47 and 48:
Page 49 and 50:
Page 51 and 52:
Page 53 and 54:
Page 55 and 56:
Page 57 and 58:
Page 59 and 60:
Page 61 and 62:
Page 63 and 64:
Page 65 and 66:
Page 67 and 68:
Page 69 and 70:
Page 71 and 72:
Page 73 and 74:
Page 75 and 76:
Page 77 and 78:
Page 79 and 80:
Page 81 and 82:
Page 83 and 84:
Page 85 and 86:
Page 87 and 88:
Page 89 and 90:
Page 91 and 92:
Page 93 and 94:
Page 95 and 96:
Page 97 and 98:
Page 99 and 100:
Page 101 and 102:
Page 103 and 104:
Page 105 and 106:
Page 107 and 108:
Page 109 and 110:
Page 111 and 112:
Page 113 and 114:
Page 115 and 116:
Page 117 and 118:
Page 119 and 120:
Page 121 and 122:
Page 123 and 124:
Page 125 and 126:
Page 127 and 128:
Page 129 and 130:
Page 131 and 132:
Page 133 and 134:
Page 135 and 136:
Page 137 and 138:
Page 139 and 140:
Page 141 and 142:
Page 143 and 144:
Page 145 and 146:
Page 147 and 148:
Page 149 and 150:
Page 151 and 152:
Page 153 and 154:
Page 155 and 156:
Page 157 and 158:
Page 159 and 160:
Page 161 and 162:
Page 163 and 164:
Page 165 and 166:
Page 167 and 168:
Page 169 and 170:
Page 171 and 172:
Page 173 and 174:
Page 175 and 176: KCE reports 57 Musculoskeletal & Ne
Page 225: KCE reports 57 Musculoskeletal & Ne
Page 249 and 250: KCE Reporst 57 Musculoskeletal & Ne
Page 275 and 276: KCE Reports 57 Musculoskeletal & Ne
Page 277 and 278:
Page 279 and 280:
Page 281 and 282:
Page 283 and 284:
Page 285 and 286:
Page 287 and 288:
Page 289 and 290:
Page 291:
Page 294 and 295:
Dépôt légal : D/2007/10.273/19
Page 296:
35. Etude relative aux coûts poten
show all

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

You also want an ePaper? Increase the reach of your titles

Delete template?

Save as template?