Effectiveness of intermediate phase stroke inpatient rehabilitation in intermediate ward versus conventional rehabilitation at community hospital
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Abstract
BACKGROUND: Chiangrai Prachanukroh hospital had implemented the government policy for intermediate care in stroke patients at the community hospital, but had not compared the effectiveness, the hospital charges and diagnosis related groups (DRGs) payment with the conventional method.
OBJECTIVE: To compare the effectiveness of stroke inpatient rehabilitation, the hospital charges and diagnosis related groups (DRGs) payment between intermediate ward and conventional ward at the community hospital.
METHODS: Prospective cohort study in intermediate phase stroke patients admitted for inpatient rehabilitation, intermediate ward and conventional ward during March 2020 to April 2021. The patients’ demographic data was recorded on the admission day and the modified Barthel index of activities of daily living (BI) was recorded on the admission day, the discharge day, 3 months after discharged and 6 months after discharged. The effectiveness was defined as the difference of BI on the admission day and the discharge day. After that, the hospital charges and diagnosis related groups (DRGs) payment were recorded. The data were analyzed by t-test, exact probability test, rank sum test and the multivariable mean difference regression analysis (Gaussian regression).
RESULTS: This study was 105 patients (55 patients in the intermediate ward and 50 patients in the conventional ward). The average age was 66.84±10.63 years. The effectiveness and the hospital charges of stroke patient in the intermediate ward were increased significantly higher than in the conventional ward (5.18±3.20 VS. 3.36±2.38 scores, p=0.008 and 13,384.16±7,878.11 VS. 4,332.83±4,023.37 Baht/person/admission, p<0.001, respectively). But the diagnosis related groups (DRGs) payment was significantly lower in the intermediate ward than in the conventional ward (10,338.02±3,396.72 VS. 12,526.13±7,576.30 Baht/person/admission, p<0.010).
Conclusions and Reccommendations: Intermediate phase stroke patients receiving inpatient rehabilitation in the intermediate ward had the effectiveness and the hospital charges significantly higher than in the conventional ward at the community hospital. But the diagnosis related groups (DRGs) payment was significantly lower in the intermediate ward than in the conventional ward. So, the related factors of the effectiveness, the hospital charges and the diagnosis related groups (DRGs) payment for this area should be in the further study.
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