Utilization of rehabilitation services for inpatient with cancer in Taiwan: a descriptive analysis from national health insurance database.

BACKGROUND: Cancer is a major cause of global morbidity and mortality. Since a high prevalence of functional impairments has been observed among cancer patients, rehabilitation has been proposed as a strategy to restore patients' functional independence. The increasing number of cancer patients combined with a growing need for rehabilitation may result in increased utilization of rehabilitation services. This study aimed to investigate the utilization of rehabilitation services among hospitalized cancer patients in Taiwan between 2004 and 2008. METHODS: Annual admissions and total inpatient expenditures for admissions with a cancer diagnosis were calculated from the National Health Insurance Research Database (NHIRD). Rehabilitation services used by cancer and non-cancer patients, as well as the distributions of rehabilitation service type among the different hospital departments were also analyzed. RESULTS: The percentages of inpatient admissions with a cancer diagnosis increased from 14.01% to 17.1% between 2004 and 2008. During 2004, 5.25% of all inpatient admissions received rehabilitation services; this percentage increased to 5.62% by 2008. Among cancer admissions, 2.26% to 2.62% received rehabilitation services from 2004 to 2008. By comparison, 5.68% to 6.24% of non-cancer admissions received rehabilitation services during this period. Of the admissions who received rehabilitation services, only 6.44% and 7.96% had a cancer diagnosis in 2004 and 2008, respectively. Sixty-one percent of rehabilitation services were delivered in the departments of orthopedics (25.6%), neurology (14.4%), rehabilitation (11.9%), and neurosurgery (9.2%). CONCLUSIONS: In Taiwan, the utilization of rehabilitation services during hospitalization increased from 2004 to 2008. Although this trend was noted for cancer and non-cancer admissions, the utilization of rehabilitation services was generally greater by non-cancer admissions. Despite the benefits of rehabilitation, the actual rehabilitation needs of cancer patients remain unmet.

Rehabilitation after hip fracture--equal opportunity for all?

OBJECTIVES: To determine whether factors unrelated to clinical appropriateness affect use of physical and occupational therapy (PT/OT) in elderly Medicare patients with acute hip fracture. DESIGN: Bivariate and multivariate analysis of detailed clinical data retrospectively gathered from medical records and of nonclinical variables obtained through linkage with the American Hospital Association data base. SETTING: 297 randomly selected hospitals from 5 states. PATIENTS: 2,762 elderly Medicare patients hospitalized with a primary diagnosis of acute hip fracture who were hospitalized during 1981-1982 or 1985-1986. INTERVENTION: Observational study. MAIN OUTCOME MEASURES: Initiation and intensity of PT/OT while in the acute hospital. RESULTS: We found evidence that factors not relevant to clinical appropriateness, such as race, hospital size, and state, significantly affect whether patients receive any PT/OT after acute fracture, as well as the intensity of PT/OT. For example, after controlling for patient clinical characteristics, we found that 63% of African-American patients received low-intensity PT/OT in comparison to 43% among non-African-American, and we found threefold differences among states both in initiation of PT/OT and in the intensity of its use. Overall, clinical characteristics had relatively greater influence on whether patients started PT/OT, whereas factors not relevant to clinical appropriateness had relatively greater influence on how much rehabilitation was provided. CONCLUSION: There are significant disparities in use of rehabilitation after hip fracture, only partially explained by patient clinical characteristics. Factors without obvious relevance to the clinical appropriateness of PT/OT exert a significant influence on use of rehabilitation services, particularly on the intensity of their use.

Evaluation of the cost effectiveness of therapist computerized entry of occupational therapy workload measurement data.

A study was conducted to examine the cost effectiveness of two methods of managing occupational therapy workload measurement data. The computer entry of statistical data by a clerk in a central location was compared to multi-site direct input of data by therapists. Cost effectiveness, efficiency and accuracy of each method were the primary outcomes. Ease of coordination and level of computer comfort were secondary outcomes. It was clear that clerk entry of data was more cost effective, efficient and accurate than therapist entry of data. The monitoring of monthly data entry was best facilitated by clerk entry. Therapists had a positive attitude towards direct entry but were unable to approximate the speed and accuracy of the data entry clerk. Therapists' comfort with computers increased slightly during the study. Since the prime purpose of the study was to examine cost effectiveness, it was concluded that clerk entry of workload data is the best use of resources.

Maintaining a balance in service and education in a climate of fiscal crisis.

Doubling enrollment in the undergraduate occupational therapy programme at McMaster University was introduced in a climate of fiscal crisis. This paper will discuss the creative implementation of a Quality Circle Model in the Occupational Therapy Department at Chedoke-McMaster Hospitals, Hamilton, Ontario, which promoted concerted staff participation and self management development in light of increased student learning needs. An alternate model of Clinical Supervision was examined. The impact of this proactive, problem solving approach will be addressed and may encourage application in other occupational therapy settings.

Surviving the management game: workload measurement systems in a cost-conscious environment.

Using a procedure-based occupational therapy workload measurement system developed at, and applied by, Sunnybrook Health Science Centre, this paper explores the objectives of such a system from the point of view of the occupational therapy manager. It also takes into account the synergistic relationship between the occupational therapist and the administrative/business aspect of health care, paying special attention to past and present trends in health-care accountability. In this paper it is argued that occupational therapy managers must relate their procedures and overhead costs to actual client care, if they are to be included in programme management and client costing. The process used by occupational therapy to describe its own procedures for the system is outlined. The system was then developed in conjunction with other institutional, financial and management tools for the client cost conversion process. By using a procedure based workload measurement system, occupational therapy is able to accurately describe client costing, thereby articulating our role in client care.

Productivity analysis.

This paper discusses productivity analysis, a method used in the Department of Rehabilitation Services at the Brigham and Women's Hospital in Boston to measure the efficiency of occupational therapy services. Input and output information forms are displayed for a computerized program of productivity analysis. Input information includes time and nontime (modality) units and scheduled downtime. Output reports contain productivity analyses which allow the manager to monitor the ratio between actual hours worked by therapists and allocated hours per service. The data generated give weekly, monthly, and yearly feedback on performance by service and discipline. The objective information produced by these reports on service and department function contributes to management decisions on resource allocation and equipment requests.

A cost analysis and management reporting system in occupational therapy.

Productivity management through cost analysis is fundamental in today's health care. A description of a cost analysis and management reporting system based on relative value units is presented in this article along with a practical method of identifying variable, fixed, and total costs for occupational therapy. Occupational therapy management participation in the cost analysis process is also discussed.

The Medicare prospective payment system.

In 1983 Congress adopted the most significant change in the Medicare program since its inception in 1965. Along with measures to ensure the solvency of the Social Security System into the next century, Congress approved a system of prospective payment for hospital inpatient services, whereby hospitals are paid a fixed sum per case according to a schedule of diagnosis related groups (DRGs). The program will be phased in over a four-year period that began October 1, 1983. Several types of hospitals and distinct part units of general hospitals are excluded from the system until 1985, when Congress will receive a report on a method of paying them prospectively. Information used to calculate the DRG rates was published September 1, 1983, as part of the interim final regulations. Other third party payers, such as state Medicaid systems and insurance companies, are considering converting to this method of payment, and several have adopted it. The implications for occupational therapy include a greater emphasis on reducing hospital length of stay, expanding outpatient care, increasing productivity, and a trend toward documentation and accounting consistent with computer technology.

Micro-costing analysis: a measure of accountability.

A description of a micro-costing analysis conducted by the Psychiatric Occupational Therapy Department at Rush-Presbyterian St. Luke's Medical Center is reported. Analysis enabled a department manager to establish cost estimates for the services provided by the department. Included are data reflective of both costs and overhead. The analysis generates information concerning the relative amount of labor used, projected annual volumes, costs for direct and indirect labor, overtime, direct and indirect supplies, allocated cost, and cost for each identified evaluation and/or treatment. Access to cost information enables the department manager to realistically establish charges and to assess efficient use of personnel and supplies. The micro-costing analysis provides a vehicle to communicate departmental needs to the hospital administration based upon documented use of resources, and justified by a thorough cost breakdown.

Establishing and administrating a private practice in a hospital setting.

This paper presents specific guidelines for establishing a private practice in an institution. Guidelines are discussed for structuring the practice, establishing the fee schedule, the billing procedures, proposals and contracts, general organization and administration, together with the expansion and termination of the practice for a client/institution.