Het gebruik van kinesitherapie en van fysische geneeskunde ... - KCE

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48 Physiotherapy & Physical and Rehabilitation Medicine KCE reports 87 4 DESCRIPTION AND ANALYSIS OF THE CONSUMPTION OF REHABILITATION CARE FOR SOME SPECIFIC SURGERY PROCEDURES 4.1 RESEARCH QUESTIONS AND METHODOLOGY 4.1.1 Research question The objective of this part is to identify variables that predict the type of rehabilitation e.g. variables linked to the health care context (hospital or physician), the type of intervention and the patient’s socio-demographic characteristics. First, cost and number of sessions were studied in detail. Second, a statistical model was developed that looked for an explanation of this consumption. 4.1.2 Descriptive statistical analysis of rehabilitation consumption Statistical analyses (descriptive and explanatory) of consumption related to rehabilitation for specific surgical procedures include: • The number of sessions, under the K and M nomenclature codes (outpatient and inpatient); • The duration of rehabilitation treatment; • The cost of care, based on the type of coverage (physiotherapy or mono- or multi-disciplinary PRM). For each surgical intervention under study the analyses examine significant differences between five pathways of rehabilitation: mono-disciplinary PRM, multi-disciplinary PRM, PT, mixture of PT and mono-disciplinary PRM, mixture of PT and multi-disciplinary PRM. 4.1.3 Construction of an explanatory model of the type of treatment prescribed in first instance A logistic regression model will consider the type of treatment followed in first instance: mono-disciplinary PRM, multi-disciplinary PRM and physiotherapy. A simple binary model tests the probability of treatment by PRM versus physiotherapy. Another model tests the probability of treatment by multi-disciplinary PRM versus mono-disciplinary rehabilitation (PT or PRM). 4.1.4 Data limits and methodological choices The IMA provides claims data on the services covered by the compulsory health insurance, labelled with nomenclature codes and delivered in both ambulatory care settings and hospitals. Data contain all interventions paid by the national compulsory health insurance and all rehabilitation occurring one year after these surgical procedures. Claims data do not register the reason for which a patient is treated or examined; there is no registration of diagnosis, co-morbidities or complications. Registration of those diagnoses is provided by the clinical minimum data set for hospitalised patients. However, the deadlines did not allow using these data as they are only available and validated at least 3 years after registration.
KCE Reports 87 Physiotherapy & Physical and Rehabilitation Medicine 49 4.1.5 Limits related to the selection of the surgical interventions The choice of surgical procedures, mainly orthopaedic ones, j does not allow drawing global conclusions on the whole of PRM in Belgium. Nevertheless, the data provide important information on the selected surgical interventions. These interventions represent a significant part of the total activity of multi-disciplinary PRM in the compulsory health insurance system k . The most important surgical procedures that require physiotherapy or PRM were targeted. These procedures are usually followed by rehabilitation treatment invoiced according to the nomenclature K or M. The intervention justifies the necessity for rehabilitation but there is no information on complication or co-morbidity. The interventions under study usually require mono-disciplinary rehabilitation. The choice between mono- and multi-disciplinary rehabilitation sometimes depends on the situation of the patient. For specific disorders, such as stroke (CVA), multi-disciplinary rehabilitation is a recommendation of good clinical practice. However, neurological disorders, which represent a major part of the PRM activity, were not selected because the differences in functional status of this group are too important. This heterogeneity could not be reduced since information on the functional status was not available. Neurological disorders were therefore deliberately excluded from the analysis. To maximize homogeneity, we also excluded all procedures that are not done on a “regular” base. Finally, situations that can benefit from conventions were also excluded. Most procedures are performed during classical hospitalisation, with the exception of two procedures often performed in outpatient: • Carpal tunnel release (nomenclature code 287836) • Meniscectomy (nomenclature code 300333). 4.1.6 Classification of surgery procedures The surgical procedures selected were grouped (Table 17). These groups were dictated by the nature of the procedures, their mutual anatomical site and possible similar seriousness. It has been checked that there were no noticeable differences between the procedures grouped together for the distributions of • prevalence of the different type of rehabilitation beginning the rehabilitation course; • the combination of rehabilitation during the care episodes; • the length of hospital stay; • the number of sessions for each type of rehabilitation; • the length of the rehabilitation episodes for each type of rehabilitation; • delay between the surgical intervention and the first rehabilitation treatment; • proportion of episodes excluded. In particular, for the group of femoral fracture, no major differences were observed between surgical treatment by osteo-synthesis (i.e. fusion) and by prosthesis. There are, however, differences for distribution of age (year) between surgery for fracture of diaphysis of femur (mean = 59 years old; median = 69 years old and lower quartile = 29 years old), and the other operations put in the same group (mean > 74 years old; median > 79 years old; lower quartile > 67 years old). But no differences were observed for the variables listed above. j This group of orthopaedic interventions still represents almost 50% of the disorders motivating multidisciplinary PRM. Source: Christian sickness fund; On 24 980 disease-mentions for its members in 2006: 37.2 % are for 402 A listed complaints, 13.4 % for 404A listed complaints et 11.5% for 501B listed complaints). k By comparison with RIZIV-INAMI data in 2005, the rehabilitation for these surgery procedures (only the rehabilitation after application of all exclusion criteria) counted for 22% of K30 sessions, 25% of K60 sessions multi-disciplinary PRM and 40% of PT sessions for Fa-listed conditions.
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