You are not logged in. Press here to login.

Content

List volumes - List articles in this issue

Original report

Evaluating inpatient public rehabilitation in Australia using a utilization review tool developed in North America

doi: 10.2340/16501977-0506

Open access

Abstract:

OBJECTIVE: To evaluate inpatient rehabilitation in public facilities in Australia against a utilization review tool used in the USA.
DESIGN: Prospective cohort study.
SUBJECTS: Patients identified in the acute wards of a regional referral hospital and subsequently transferred to a public inpatient rehabilitation facility.
METHODS: The InterQual utilization review criteria were app­lied to days of stay in the rehabilitation wards. Reasons for variance and actual therapy time were recorded.
RESULTS: Data on 267 patient episodes (7359 days) are available. Only 48% of patient days met utilization review criteria, with reasons for variance including insufficient therapy, awaiting discharge to long-term care or to home and being more appropriate for acute medical care. Therapy time data (available on 208 patient episodes) show that therapy was received on 50% of calendar days and for an average of 37 min per weekday (56 min for stroke patients). Allied health staffing levels were below recommended levels, but consistent with other Australian public hospital rehabilitation facilities.
CONCLUSION: Patients in these facilities seem to be receiving less therapy than their American counterparts; however, therapists often viewed their rehabilitation as appropriate. Findings also suggest inefficiencies in care delivery. Utilization review may help in the assessment of level of care appropriateness in the rehabilitation setting.

Authors:

Christopher J. Poulos

References

  1. Cameron PA. Hospital overcrowding: a threat to patient safety? [Comment]. Med J Aust 2006; 184: 203–204.
  2. Braitberg G. Emergency department overcrowding: dying to get in? Med J Aust 2007; 187: 624–625.
  3. New PW, Poulos CJ. Functional improvement of the Australian health care system – can rehabilitation assist? Med J Aust 2008; 189: 340–343.
  4. Simmonds F, Stevermuer T. The AROC annual report: the state of rehabilitation in Australia 2006. Aust Health Rev 2008; 32: 85–110.
  5. Australasian Faculty of Rehabilitation Medicine.Standards 2005. Adult Rehabilitation Medicine Services in Public and Private Hospitals. [cited 2009 August 1] Available from: http://afrm.racp.edu.au/download.cfm?DownloadFile=086EBD98-B3AF-7650-B32546CB8C28EAE5
  6. Allied Health in Rehabilitation Consultative Committee. Guidelines for Allied Health – resources required for the provision of quality rehabilitation services. 2007. [cited 2009 August 1] Available from: http:http://www.speechpathologyaustralia.org.au/library/workforce/V10_Guidelines_for_AHR_Rehabilitation.pdf
  7. Medical Inpatient Rehabilitation Criteria Task Force. Standards for Assessing Medical Appropriateness Criteria for Admitting Patients to Rehabilitation Hospitals or Units. [cited 2009 August 1] Available from: http://www.aapmr.org/zdocs/hpl/MIRC0906.pdf
  8. Poulos CJ, Eagar K. Determining appropriateness for rehabilitation or other subacute care: is there a role for utilisation review? Aust New Zealand Health Policy 2007; 4: 3.
  9. Flintoft VF, Williams JI, Williams RC, Basinski AS, Blackstien-Hirsch P, Naylor CD. The need for acute, subacute and nonacute care at 105 general hospital sites in Ontario. Joint Policy and Planning Committee Non-Acute Hospitalization Project Working Group CMAJ 1998; 158: 1289–1296.
  10. Smith CB, Goldman RL, Martin DC, Williamson J, Weir C, Beauchamp C, et al. Overutilization of acute-care beds in Veterans Affairs hospitals. Medical Care 1996; 34: 85–96.
  11. Poulos CJ, Eagar K, Poulos RG. Managing the interface between acute care and rehabilitation - can utilisation review assist? Aust Health Review 2007; 31: 129–140.
  12. Uniform Data System for Medical Rehabilitation. Guide for the Uniform Data Set for Medical Rehabilitation (Adult FIM™) version 5.1. Buffalo, NY; 1997.
  13. Baggerly J, Belmosto L, Drinkwater J, Mosher M. Patient readiness for scheduled therapies: nursing’s positive contribution. Rehabil Nurs 1995; 20: 161–163.
  14. Cifu DX, Kreutzer JS, Kolakowsky-Hayner SA, Marwitz JH, Englander J. The relationship between therapy intensity and rehabilitative outcomes after traumatic brain injury: a multicenter analysis. Arch Phys Med Rehabil 2003; 84: 1441–1448.
  15. Teasell R, Bitensky J, Salter K, Bayona NA. The role of timing and intensity of rehabilitation therapies. Top Stroke Rehabil 2005; 12: 46–57.
  16. Kwakkel G, van Peppen R, Wagenaar RC, Wood Dauphinee S, Richards C, Ashburn A, et al. Effects of augmented exercise therapy time after stroke: a meta-analysis. Stroke 2004; 35: 2529–2539.
  17. Kwakkel G. Impact of intensity of practice after stroke: issues for consideration. Disabil Rehabil 2006; 28: 823–830.
  18. Shiel A, Burn JP, Henry D, Clark J, Wilson BA, Burnett ME, et al. The effects of increased rehabilitation therapy after brain injury: results of a prospective controlled trial. Clin Rehabil 2001; 15: 501–514.
  19. Slade A, Tennant A, Chamberlain MA. A randomised controlled trial to determine the effect of intensity of therapy upon length of stay in a neurological rehabilitation setting. J Rehabil Med 2002; 34: 260–266.
  20. Hellweg S, Johannes S. Physiotherapy after traumatic brain injury: a systematic review of the literature. Brain Inj 2008; 22: 365–373.
  21. Jette DU, Warren RL, Wirtalla C. The relation between therapy intensity and outcomes of rehabilitation in skilled nursing facilities. Arch Phys Med Rehabil 2005; 86: 373–379.
  22. Zhu XL, Poon WS, Chan CC, Chan SS. Does intensive rehabilitation improve the functional outcome of patients with traumatic brain injury (TBI)? A randomized controlled trial. Brain Inj 2007; 21: 681–690.
  23. Chen CC, Heinemann AW, Granger CV, Linn RT. Functional gains and therapy intensity during subacute rehabilitation: a study of 20 facilities. Arch Phys Med Rehabil 2002; 83: 1514–1523.
  24. Page SJ. The role of timing and intensity of rehabilitation therapies. Top Stroke Rehabil 2006; 13: viii–ix; author reply ix–x.
  25. Weinrich M, Good DC, Reding M, Roth EJ, Cifu DX, Silver KH, et al. Timing, intensity, and duration of rehabilitation for hip fracture and stroke: report of a workshop at the National Center for Medical Rehabilitation Research. Neurorehabil Neural Repair 2004; 18: 12–28.


Related articles

There are no related articles.


Actions


Abstract

Full text

PDF

Supplementary


There is no supplementary for this article.

Related articles


Click here to show related articles

Print information


Volume 42, Issue 3

DOI: 10.2340/16501977-0506

Pages: 246-253

View at PubMed