Neuro-rehabilitation Australian Experience

Transcription

1 Neuro-rehabilitation Australian Experience The 4 th World Congress for NeuroRehabilitation J E (Ben) Marosszeky Tara Stevermuer Janette Green

2 REHABILITATION - PATIENT S PERSPECTIVE A PATIENT S VIEW OF REHABILITATION Recovering from sever drug induced cerebellar ataxia

3 Neuro-rehabilitation - Australia The information presented herewith is made possible by using data held by the Australasian Rehabilitation Outcomes Centre AROC

4 What is AROC? AROC is a joint initiative of the Australian rehabilitation sector (providers, payers, regulators and consumers) The Australasian Faculty of Rehabilitation Medicine of the RACP is the auspice body and data custodian The Centre for Health Service Development (CHSD) at the University of Wollongong is the data manager and responsible everyday running of AROC

5 What is AROC? Established as a not-for-profit self-funding centre with its own management board, attached to CHSD Operating since July, 2002 Over 200,000 episodes of rehabilitation have been received from 110 of the 130 known rehabilitation facilities operated either by the public or private sector

6 Neuro-rehabilitation - Australia AROC has five roles A national data bureau that receives and manages data on the performance of rehabilitation services in Australia. 2. The national benchmarking centre for medical rehabilitation. 3. The national certification centre for the Functional Independence Measures (FIM) (instruments designed to measure functional needs and outcomes).

7 AROC has five roles An education and training centre for the FIM and other rehabilitation outcome measures. 5. A research and development centre that develops research and health service development proposals and seeks external funding for its research agenda.

8 Neuro-rehabilitation Australia Number of episodes of care in last 3 years Impairment Groups Frequency Percent % Stroke Brain Neuro Spine Total This constitutes 23.6% of all episodes

9 Impairment Groups Years Total Stroke Brain Neuro Spine Total EPISODES 5000 Numbers Stroke Brain Neuro Spine Impairments

10 AGE of Patients Impairment Groups Mean 95% Confidence Interval for Mean Low er Bound Upper Bound Stroke Brain Neuro Spine

11 GENDER Impairment Male Female Not stated Total Groups n % of total n reported Stroke % Brain % Neuro % Spine % Total %

12 Neuro-rehabilitation Australia Number of Episodes by Sector Impairment Sector of treating facility Groups Public Private Stroke % % 66.6% Public/Private % Brain % % 71.4% Neuro % % 41.5% Spine % % 74.2% Total % %

13 Neuro-rehabilitation Australia Beginning of rehab episode from Usual Other Another Own Hospital Other Not stated Total Accom than usual hosp Stroke Brain Neuro Spine % 13.9% 0.4% 56.7% 23.6% 3.2% 2.2% 100.0%

14 Pre - Hospital Accomodation Impairment Private Nursing Transitional Hostel Community Boarding Groups residence home Care Other Total Stroke Brain Neuro Spine Total % 95.2% 2.6% 0.4% 0.1% 0.0% 0.0% 1.6% 100.0% Not stated = 23.8%

15 Pre-Hospital Living arrangements Alone Spouse Spouse Family Community Other not stated Total & family Stroke Brain Neuro Spine Total % 11.2% 25.1% 1.3% 62.4% 100.0% Information relates to patients admitted from private residence

16 OUTCOME MEASURES FUNCTIONAL ENABLING FIM DISCHARGE SCORE - FIM RATE OF CHANGE (GAIN/WEEK) LENGTH OF STAY RATE OF RETURNING TO COMMUNITY LIVING

17 Valid FIM score Yes No Total Stroke Brain Neuro Spine % 95.4% 4.6% 100.0%

18 FIM Admission Score Impairment Groups Mean 95% Confidence Interval for Mean Low er Bound Upper Bound Stroke Brain Neuro Spine

19 Impairment Groups FIM Discharge Score Mean 95% Confidence Interval for Mean Low er Bound Upper Bound Stroke Brain Neuro Spine

20 Impairment Groups Neurorehabilitation - Australia Mean Length of stay 95% Confidence Interval for Mean Low er Bound Upper Bound Median Stroke Brain Neuro Spine

21 Length of stay for Stroke 1, No. Episodes Days Mean = Std. Dev. = N = 12,434

22 Length of stay for Brain No. Episodes Days Mean = Std. Dev. = N = 2,983

23 Length of stay for Neuro No. Episodes Days Mean = 20.4 Std. Dev. = N = 5,044

24 Length of stay for Spine No. Episodes Days Mean = 33.3 Std. Dev. = N = 1,855

25 FIM gain/week Mean 95% Confidence Interval for Mean Lower Bound Upper Bound Stroke Brain Neuro Spine

26 Brain Impairment Group N % Age LOS FIM Adm FIM Disch Non-traumatic % Traumatic 1, % Other 1, % Other = not classified as open or closed

27 Spinal Impairment Group N % Age LOS FIM Adm FIM Disch Non-traumatic % Traumatic % Other % Other = not classified as para- or quadriplegia

28 At the Episode end Usual Accom Interim accom Care type Acute care Own risk Other Death Not stated Total Stroke Brain Neuro Spine % 81.3% 2.8% 11.7% 0.5% 3.0% 0.5% 0.2% 100.0%

29 Impairment Groups Private residence Post-Hospital accommodation Hostel Community Boarding Nursing home Transitional Other Total Stroke Brain Neuro Spine Total % 9.2% 0.6% 9.8% 100.0% Available for 32.6% of total sample

30 This information suggests that the Australian in-patient rehabilitation programs meet the internationally achieved best practice standards. The establishment of AROC will enable the Australian rehabilitation services to develop benchmarks for all impairment groups and more importantly monitor the benefits to changes of treatment and service delivery. We are also working diligently to promote the recently formed International Rehabilitation Outcomes Network (IRON) to improve the ability to share the benefits of practice and service developments for the benefit for our patients.

31 Invite you to the AROC Website