Abuzahra, M. and Piso, B. (2009): Classification of disease severity for neuro- and trauma rehabilitation Part 2: International experiences with quality / performance assessments and reimbursement . HTA-Projektbericht 023b.
Background: Neurologic and traumatologic rehabilitation are highly complex. The evaluation of quality and performance is important in order to meet the requirements of patients, care providers and funders of health care. Increased efficiency can be achieved by using outcome-oriented payment models. Differentiation by severity of disease using generic (overall diagnosis) assessment instruments could be used in quality measurement and linked to reimbursement systems.
Method: This report considers whether and which generic assessment instruments are used in quality and performance measurement, or in determining levels of reimbursement, in neuro and trauma rehabilitation. In particular, it explores international experiences with such instruments. A systematic literature review and a selective internet search were conducted in order to answer these questions.
Results: In Germany and in Switzerland pilot studies of generic instruments for quality and performance measurement are being conducted. In Australia the AROC (Australasian Rehabilitation Outcome Centre) carries out quality measurement in rehabilitation almost nationwide, and uses the FIM (Functional Independency Measure). The application of generic instruments in outcome orientated payment systems has been tested in Germany using the FIM and the SINGER (Selbstständigkeitsindex für die neurologische und geriatrische Rehabilitation). In Switzerland, the LTR (leistungsorientiertes Tarifmodell, performance-oriented tariff model) is currently being tested. In Great Britain the RCS (Rehabilitation Complexity Scale), the NPDS (Northwick Park nursing Dependency Scale), and the NPTDA (Northwick Park Therapy Dependency Assessment) have been developed and are currently being piloted. In Australia the AN-SNAP-Classification (Australian National Sub-acute and Non-acute Patient Classification System), in which the differentiation of severity is based on the FIM, has been developed. In the USA the FIM has been in use for the differentiation of severity in the PPS (Prospective Payment System) since 2002.
Most of the studies reviewed which discuss the use of generic instruments in reimbursement are from the USA. For the most part, they evaluate the PPS. The costs of neuro and trauma rehabilitation are higher than the level of reimbursement designated by the PPS. Since the implementation of the PPS, the average length of stay has decreased and rate of discharges to home has increased.
Conclusion: Generic Instruments can be used for various purposes. In Austria, pilot projects of the use of generic instruments for the measurement of quality and/or reimbursement, which take into consideration previous international experiences and projects, are recommended.