The Effect of the Introduction of a Case-Mix−Based Funding Model of Rehabilitation for Severe Stroke: An Australian Experience

Brock KA, Vale SJ, Cotton SM. The effect of the introduction of a case-mix–based funding model of rehabilitation for severe stroke: an Australian experience.ObjectiveTo compare resource use of, and outcomes for, rehabilitation for severe stroke before and after the implementation of the Casemix and Rehabilitation Funding Tree case-mix−based funding model.DesignProspective, observational cohort study.SettingEight inpatient rehabilitation centers in Australia.ParticipantsConsecutive sample of 609 patients with severe stroke.InterventionsNot applicable.Main Outcome MeasuresRehabilitation length of stay (LOS), discharge destination, and FIM instrument motor score at discharge.ResultsThe average rehabilitation LOS changed significantly between the preimplementation year and the implementation year (Mann-Whitney U, P=.001). There were no significant differences in discharge destination. FIM motor score at discharge showed significant reduction in improvement (Mann-Whitney U, P=.001) between the preimplementation year and the implementation year. There were no significant correlations between LOS in rehabilitation and gain in function for either the preimplementation year (Spearman ρ, P=.07) or the implementation year (P=.15).ConclusionsThe change in funding model was associated with a decrease in inpatient costs and with an associated increase in disability at discharge. Our results suggest that the rate of improvement in severe stroke is variable; also, they support the use of funding models for stroke rehabilitation that allow flexibility in resource allocation.