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

KCE reports 57 Musculoskeletal & Neurological Rehabilitation 39
For a further assessment of the advantages and disadvantages of the listed patient
classification systems, the results of other research teams were summarised.
Concerning PCS for inpatient rehabilitation, the team at the University of Wollongong
(see 3.5.2, Australian National Sub-acute and Non-acute Patient classification) concluded
that the more variables were used to classify patients, the better the predictive value of
the required resources. Of the compared PCS, FIM-FRG and AN-SNAP scored best.
Selection of the ‘best’ classification involves a trade-off between simplicity and accuracy
and whether the classification is already in use elsewhere, in order to benchmark.
Concerning PCS for outpatient rehabilitation, this team concluded the preferred option
was highly dependent on the model selected for the classification of inpatient care to
facilitate transfers and follow up of individuals. 15
A report was found including a comparison of Patient Classification Systems using
predefined selection criteria without testing these instruments with a data set {Rapport
rédigé par les membres du CoPil sur la base d'un travail de recherche de M.Nicolas
Jeanprêtre, 2002, 104}. For this comparison, no distinction was made between in- and
outpatient classification systems. MDS-PAC, AN-SNAP, PMSI-SSR, TAR-FIM and RUG-III
were compared and AN-SNAP was selected model as the best patient classification
system. The main comment on this system was that it does not include prognostic
indicators for the medical evolution.
The preference for one or another patient classification system depends on the application
possibilities. Ideally, a Patient Classification System supports patient referral to the most
appropriate rehabilitation programme which is determining the required resources. The
PCS currently used to support resource allocation show the important restriction that
not the real rehabilitation needs are covered but rather the care needs by using the FIM
and Barthel Index. The International Classification of Functioning, disability and health is
not yet tested on validity related to patient referral and/or resource allocation, and as
such is not ready to use yet. However, scientific work on this subject is going on, including
research on how to convert the existing PCS to the future ICF-based PCS. Another
problem is that for most PCS, it will be a challenge to tune an inpatient to an outpatient
classification.
3.6 FRAMEWORK FOR SELECTION OF THERAPY
3.6.1 Introduction
In the definition of rehabilitation two conditions for therapy are:
• Interventions must be evidence based;
• Interventions must have a proven added value to achieve the defined goals.
Criteria to evaluate therapy concerning evidence, proven added value and quality are
essential.
First, the focus is on criteria for the selection of interventions to compound a
rehabilitation programme. Numerous factors influence the individuals’ decision-making
when planning care across the continuum. Patient, environment and disease related factors
are critical. Taking these factors into account is essential in selecting appropriate
intervention strategies in any disease stage. 115
In chapter 8 models for quality assessment will be discussed. Current clinical practice in
Belgium will be compared to clinical pathways developed in different countries (chapter 6
and 7).
The complexity and interaction of the criteria which determine a therapy plan for an
individual, requires a framework permitting a health professional to have a detailed view
on the individuals’ situation. This is in contrast with the framework used for resource
planning, which has to be easy manageable for financial analysts and policy-makers.