Neuro-rehabilitation Australian Experience The 4 th World Congress for NeuroRehabilitation J E (Ben) Marosszeky Tara Stevermuer Janette Green
REHABILITATION - PATIENT S PERSPECTIVE A PATIENT S VIEW OF REHABILITATION Recovering from sever drug induced cerebellar ataxia
Neuro-rehabilitation - Australia The information presented herewith is made possible by using data held by the Australasian Rehabilitation Outcomes Centre AROC
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
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
Neuro-rehabilitation - Australia AROC has five roles... 1. 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).
AROC has five roles... 4. 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.
Neuro-rehabilitation Australia Number of episodes of care in last 3 years Impairment Groups Frequency Percent % Stroke 12803 54.7 Brain 3306 14.1 Neuro 5135 21.9 Spine 2172 9.3 Total 23416 100 This constitutes 23.6% of all episodes
Impairment Groups Years 2002-2003 2003-2004 2004-2005 Total Stroke 3931 4125 4747 12803 Brain 776 991 1539 3306 Neuro 1490 1610 2035 5135 Spine 644 650 878 2172 Total 6841 7376 9199 23416 EPISODES 5000 Numbers 4000 3000 2000 1000 0 Stroke Brain Neuro Spine 2002-2003 2003-2004 2004-2005 Impairments
AGE of Patients Impairment Groups Mean 95% Confidence Interval for Mean Low er Bound Upper Bound Stroke 73.8 73.6 74.0 Brain 53.1 52.4 53.9 Neuro 68.1 67.6 68.5 Spine 56.7 55.9 57.6
GENDER Impairment Male Female Not stated Total Groups n % of total n reported Stroke 6506 51% 6188 109 12803 Brain 2121 64% 1174 11 3306 Neuro 2508 49% 2595 32 5135 Spine 1365 63% 804 3 2172 Total 12500 53% 10761 155 23416
Neuro-rehabilitation Australia Number of Episodes by Sector Impairment Sector of treating facility Groups Public Private Stroke 8523 58.3% 4280 48.7% 66.6% Public/Private % Brain 2359 16.1% 947 10.8% 71.4% Neuro 2129 14.6% 3006 34.2% 41.5% Spine 1612 11.0% 560 6.4% 74.2% Total 14623 100% 8793 100.0%
Neuro-rehabilitation Australia Beginning of rehab episode from Usual Other Another Own Hospital Other Not stated Total Accom than usual hosp Stroke 1299 43 7443 3693 187 138 12803 Brain 255 19 1928 619 257 228 3306 Neuro 1260 33 2767 899 78 98 5135 Spine 450 7 1129 316 224 46 2172 3264 102 13267 5527 746 510 23416 % 13.9% 0.4% 56.7% 23.6% 3.2% 2.2% 100.0%
Pre - Hospital Accomodation Impairment Private Nursing Transitional Hostel Community Boarding Groups residence home Care Other Total Stroke 9603 299 45 12 4 2 170 10135 Brain 2465 52 17 3 0 0 51 2588 Neuro 3431 100 10 6 0 3 36 3586 Spine 1480 18 1 0 1 1 34 1535 Total 16979 469 73 21 5 6 291 17844 % 95.2% 2.6% 0.4% 0.1% 0.0% 0.0% 1.6% 100.0% Not stated = 23.8%
Pre-Hospital Living arrangements Alone Spouse Spouse Family Community Other not stated Total & family Stroke 1037 1769 89 236 46 30 6396 9603 Brain 223 519 30 149 61 6 1477 2465 Neuro 504 954 57 120 26 14 1756 3431 Spine 139 228 32 82 18 12 969 1480 Total 1903 3470 208 587 151 62 10598 16979 % 11.2% 25.1% 1.3% 62.4% 100.0% Information relates to patients admitted from private residence
OUTCOME MEASURES FUNCTIONAL ENABLING FIM DISCHARGE SCORE - FIM RATE OF CHANGE (GAIN/WEEK) LENGTH OF STAY RATE OF RETURNING TO COMMUNITY LIVING
Valid FIM score Yes No Total Stroke 12290 513 12803 Brain 3003 303 3306 Neuro 4994 141 5135 Spine 2056 116 2172 22343 1073 23416 % 95.4% 4.6% 100.0%
FIM Admission Score Impairment Groups Mean 95% Confidence Interval for Mean Low er Bound Upper Bound Stroke 75.9 75.5 76.4 Brain 76.8 75.8 77.9 Neuro 85.9 85.2 86.5 Spine 80.7 79.7 81.7
Impairment Groups FIM Discharge Score Mean 95% Confidence Interval for Mean Low er Bound Upper Bound Stroke 95.1 94.6 95.6 Brain 95.8 94.7 96.8 Neuro 99.5 98.8 100.1 Spine 94.1 93.0 95.2
Impairment Groups Neurorehabilitation - Australia Mean Length of stay 95% Confidence Interval for Mean Low er Bound Upper Bound Median Stroke 26.9 26.5 27.2 21 Brain 27.3 26.5 28.0 21 Neuro 20.4 20.0 29.8 16 Spine 33.3 32.1 34.6 23
Length of stay for Stroke 1,000 800 No. Episodes 600 400 200 0 0 20 40 60 80 Days Mean = 26.88 Std. Dev. = 19.391 N = 12,434
Length of stay for Brain 300 250 No. Episodes 200 150 100 50 0 0 20 40 60 80 Days Mean = 27.25 Std. Dev. = 21.878 N = 2,983
Length of stay for Neuro 700 600 500 No. Episodes 400 300 200 100 0 0 20 40 60 80 Days Mean = 20.4 Std. Dev. = 15.316 N = 5,044
Length of stay for Spine 200 150 No. Episodes 100 50 0 0 20 40 60 80 Days Mean = 33.3 Std. Dev. = 27.364 N = 1,855
FIM gain/week Mean 95% Confidence Interval for Mean Lower Bound Upper Bound Stroke 5.0 5.0 5.0 Brain 4.9 4.8 4.9 Neuro 4.7 4.6 4.7 Spine 2.8 2.8 2.8
Brain Impairment Group N % Age LOS FIM Adm FIM Disch Non-traumatic 630 19.1% 61.1 26.3 76.2 93.0 Traumatic 1,328 40.2% 44.2 31.1 74.5 96.2 Other 1,348 40.8% 58.3 24.4 79.5 96.6 Other = not classified as open or closed
Spinal Impairment Group N % Age LOS FIM Adm FIM Disch Non-traumatic 911 41.9% 61.2 29.0 83.3 97.5 Traumatic 811 37.3% 48.3 44.6 75.2 87.2 Other 450 20.7% 62.9 24.8 86.6 101.1 Other = not classified as para- or quadriplegia
At the Episode end Usual Accom Interim accom Care type Acute care Own risk Other Death Not stated Total Stroke 9818 712 436 1507 61 170 83 16 12803 Brain 2282 198 59 481 24 245 7 10 3306 Neuro 4302 205 88 435 25 56 20 4 5135 Spine 1469 52 70 320 9 236 6 10 2172 17871 1167 653 2743 119 707 116 40 23416 % 81.3% 2.8% 11.7% 0.5% 3.0% 0.5% 0.2% 100.0%
Impairment Groups Private residence Post-Hospital accommodation Hostel Community Boarding Nursing home Transitional Other Total Stroke 2872 155 2 41 350 21 372 3813 Brain 1027 36 1 24 85 11 144 1328 Neuro 1566 94 1 24 103 7 125 1920 Spine 456 8 2 2 23 4 88 583 Total 5921 293 6 91 561 43 729 7644 80.5% 9.2% 0.6% 9.8% 100.0% Available for 32.6% of total sample
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.
Invite you to the AROC Website