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52 Musculoskeletal & Neurological Rehabilitation KCE reports 57 16,00 14,00 12,00 10,00 8,00 6,00 4,00 2,00 0,00 FIM: Total Score Fig. (Z): Average Total FIM Score for Stroke/Spinal Cord Injury (SCI) at admission and first follow-up. (Source: Rehabilitation Service, University Hospital Pellenberg-Leuven, Pro-Esor Study (1999-2000)). 108 87 83 76 N=21 N=12 N=8 N=5 Stroke Spinal Cord Injury Admission First F.U Time Source: Rehabilitation Service, University Hospital Pellenberg-Leuven, 2005 Figure 4.5: Average disability level of for different months of the year in 3 different rehabilitation wards in the same hospital, measured by BI January February March Arpil May June July Augustus September October November December
KCE reports 57 Musculoskeletal & Neurological Rehabilitation 53 4.5 CONCLUSIONS Currently, rehabilitation activities are not registered. Even more, the Belgian health care system is not using validated measures enabling to differentiate the different profiles of rehabilitation facilities, especially not for pathology specific characteristics. Since literature is offering some indications that minimum nursing data sets could potentially, with the necessary critical attitude, be used and further adapted for comparing rehabilitation units, it could be considered to use MVG-RIM2 as an intermediate profiling tool, using the fingerprints. It would be an intermediate tool during the period that more detailed rehabilitation registration systems are developed. The fingerprints could be used as a proxy to monitor and compare the condition of the patients within the units. However, the necessary reluctance is needed if MVG-RIM2 is intended to be used for other than nursing purposes. MVG-RIM2 is not intended for measuring rehabilitation specific purposes. Moreover, MVG-RIM2 is not allowing for pathology specific comparisons without a coupling with other datasets (MKG-RCM). If considered, the use of MVG-RIM2 should go hand in hand with thorough scaling comparisons with focused rehabilitation measures, as MVG-RIM2 is developed for nursing and not for rehabilitation purposes. The “cross-walk” exercise described in the literature, could be an example of how to deal with this issue. Last but not least, it should be kept in mind that MVG-RIM2 is developed for inpatient registration and not for routine registration of outpatient or ambulatory services. A more laborious strategy to exploit existing datasets, could consider the coupling of MVG-RIM2 with Minimal Clinical Data (MKG-RCM) and Minimal Financial Data (MFG- RFM) sets, for identifying rehabilitation activities. The MKG-RCM is a tool to differentiate on therapeutic activities. But some particular limitations have to be taken into account. The minimal clinical data set is limited to a registration of physical therapy activities, (as defined in art 7 of K.B. 18.12.2002). Medical acts that are provided in the framework of multidisciplinary rehabilitation (art. 22 K.B. 17.07.1992) will require a coupling with Minimal Financial data. Moreover there are some methodological issues to consider, when coupling datasets. To make accurate analyses of MKG-RCM data for rehabilitation purposes, one should only take into account stays in both acute and rehabilitation phases for which rehabilitation activities are done under K-nomenclature, or convention 9.50 or 7.71. It is the only strategy that enables to trace back the main diagnosis (via the “number of stay” (verblijfsnummer)). Only focusing on the registration data in rehabilitation units makes it almost impossible to trace back to the causes for rehabilitation. Code V57(.x), used for the registration for rehabilitation activities, does not require a registration of the original problem. Some secondary diagnosis for “late effect” coding is theoretically possible, but often not registered in daily practice, as this has no impact on the financing. Congruent with the international agenda, further efforts are needed to develop a specific rehabilitation registration system. In order to avoid over-registration on the ward and guarantee accurate exploitation of these date, some reflections and validation exercises are needed to fit this specific registration module in other registration models. As already mentioned in chapter 3, other countries use specific rehabilitation scales like FIM and Barthel Index for organisational and financing purposes in rehabilitation facilities. These scales, although not routinely registered in Belgium, are used in some Belgian hospitals for clinical purposes. It could be an option to introduce one of these scales in the Belgian registration system, to validate it for Belgium and to compare this exercise with experiences at the international level. An advantage of this approach would enable an international comparison of the Belgian situation, from the clinical point of view as well as from the organisational and financing point of view. One of the disadvantages however, could be the augmentation of the administrative burden that is already high in this part of medical practice.
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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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