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Post-stroke rehabilitation: an economic or medical priority? Current issues and prospects in light of new legislative regulations

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Abstract

The aim of this study was to evaluate: 1) whether the reduction in duration of in-patient rehabilitation imposed by the Italian Ministry of Health’s circular of 29/6/95 has been accompanied by a decline in the results achieved; and 2) whether the system of basing payments on diagnosis related group (DRG) criteria is capable of correctly evaluating differences in post-stroke clinical pictures.

The study involved 461 of 497 patients consecutively admitted between 1991 and 1996 for rehabilitation after a first stroke. The average duration of hospitalisation for the period 1995–1996 was significantly shorter (p<0.001) than that of the previous years; at the same time, there was a significant increase (p<0.05) in the number of poor responders in both neurological and functional (mobility) terms. Furthermore, the early discharge after 60 days of the 1995–1996 patients compromised the stabilisation of recovery and led to a subsequent functional decline. It is therefore hoped that the current regulations will be revised and that payments based on a functional related group (FRG) criterion will be introduced.

Sommario

Scopo del nostro lavoro era di valutare se 1) la riduzione della durata della degenza riabilitativa imposta dalla circolare del Ministero della Sanità del 29/6/95 si sia accompagnata o meno ad un decremento dei risultati riabilitativi; 2) se la tariffazione in base a criteri DRG sia in grado di valutare correttamente le diverse realtà dei quadri clinici post-ictali.

Lo studio è stato completato da 461 pazienti su 497 pazienti ricoverati consecutivamente tra il 1994 ed il 1996 per riabilitazione di un primo episodio ictale. La durata media della degenza nel periodo 1995–1996 è risultata significativamente (p<0.001) più corta di quella degli anni precedenti. Nel contempo si è però osservato un significativo aumento (p<0.05) dei pazienti “low responder” sia sul recupero neurologico che funzionale (mobilità). Inoltre, nei pazienti del periodo 1995–1996 dimessi al 60° giorno la precoce dimissione ha compromesso la stabilizzazione del recupero con un successive? peggioramento funzionale. Si auspica pertanto che la normativa attuale venga rivista e che si arrivi ad una retta regolata secondo un criterio FRG.

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Authors and Affiliations

  1. I.R.C.C.S. S. Lucia, University “Tor Vergata”, Via Ardeatina 306, I-00179, Roma, Italy

    S. Paolucci, M. Traballesi, L. Pratesi, S. Lubich, A. Salvia, M. G. Grasso, D. Morelli, M. Pulcini, E. Troisi & P. Coiro

  2. Epidemiology Laboratory, Institute of Hygiene, University “Tor Vergata”, Roma, Italy

    L. Emberti Gialloreti

  3. Neurology Clinic, I.R.C.C.S. S. Lucia, University “Tor Vergata”, Roma, Italy

    C. Caltagirone

Authors
  1. S. Paolucci
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  2. M. Traballesi
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  3. L. Emberti Gialloreti
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  4. L. Pratesi
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  5. S. Lubich
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  6. A. Salvia
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  7. M. G. Grasso
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  8. D. Morelli
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  9. M. Pulcini
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  10. E. Troisi
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  11. P. Coiro
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  12. C. Caltagirone
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Paolucci, S., Traballesi, M., Emberti Gialloreti, L. et al. Post-stroke rehabilitation: an economic or medical priority? Current issues and prospects in light of new legislative regulations. Ital J Neuro Sci 19, 25–31 (1998). https://doi.org/10.1007/BF03028808

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  • DOI: https://doi.org/10.1007/BF03028808

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