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252 Musculoskeletal & Neurological Rehabilitation KCE Reports 57 and define an appropriate set of data to collect in Belgium. In this validation exercise, existing Belgian registration systems like MVG-RIM2 can be taken into account (see chapter 4). Also, a cross-validation with ICF core-sets can be an option (see chapter 3). Next, a pilot registration system could be implemented, testing the feasibility of the proposed data set in the Belgian rehabilitation context. 12.3.3 Third step: Introduction/Development of a patient classification system and eventually a financing system Until now, the link between the assessment tools and the financing of rehabilitation has not been thoroughly examined. Studies on the integration of the rehabilitation tools in the financing system have been undertaken in some countries (Australia, United States, Germany, Switzerland and Canada), followed by the introduction of the developed system in the financial system of the country (see chapter 3). As mentioned in Step 2 and in previous chapters of this study, an assessment tool will be important in order to determine the patient’s rehabilitation needs and goals for organisational and financing purposes as well as to orient him/her to the adequate clinical rehabilitation services. As outlined in chapter 3, nowadays it is not possible to find a classification tool that covers organisation as well as clinical purposes (much work is going on to develop such a system based on ICF). For organisational and financing purposes, patients characterized by a similar clinical profile and a comparable level of needed resources have to be classified in homogeneous groups. A pilot study should be launched focused on the choice of the patient classification system for organisational and financing purposes (and probably another one for clinical purposes) (see chapter 3). The ongoing international studies should be kept in mind, and as soon as they are available, new international developments in this field (based on ICF) should be taken into account. Also, a cost model has to be developed, taking into account the findings in chapter 10 and 11 of this study. 12.3.4 Fourth step: Results: Organization and financing of post-acute rehabilitation care. The PCS and financing model that will be the result of the study can then be implemented. This has to go hand in hand with measures assuring quality control. Thorough registration is needed in order to dispose of the necessary data to further plan rehabilitation services.
KCE Reporst 57 Musculoskeletal & Neurological Rehabilitation 253 Figure 12.1: Stepwise development and implementation of changes in post-acute rehabilitation medicine in Belgium. Federal Institutions Steps Actions KCE report : Organisation and Financing of Musculosketal and Neurological Rehabilitation in Belgium Publication and communication of the results Developing, validating and implementing changes in post-acute rehabilitation medicine under the auspices of the Ministry of Public Step 1. Identification of patients with rehabilitation needs and goals Step 2. Selection of an appropriate functionality tool Announcement of Implementation of an evaluation tool and patient classification system for post-acute rehabilitation medicine. Selection of the Steering Committee Selection of the research team(s) Test of the "theoretical" rehabilitation definition in the rehabilitation sector Determination of the number of patients concerned by the theoretical definition Steering Committee : selection of possible assessment tools Steering Committee : validation of the selected tool in the Belgian context Steering Committee : proposition of a data set collection Pilot registration system to test the feasibility of the selected assessment tool and the data collection Step 3. Selection of possible patient classification system Introduction/Development of a patient classification system and eventually a financing system Validation of the selected system in the Belgian context Proposition of a data set collection Pilot registration system to test the feasibility of the proposed patient classification system Development of a cost model Simulations and financial propositions Step 4. Results : Organisation Planification of the rehabilitation activities in Belgium and financing of post-acute rehabilitation medicine Quality control and development of a registration system Fixation of a budget
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