Outcome Measurement in Medical Rehabilitation To plan To Assess To Improve To act To measure To Analyse
General Presentation of the CRM Functional Rehabilitation Assessment and Vocational Training Inpatient Unit 81 places Outpatient unit 46 places Relais HANDIDOM Home care (39+5 )places Sport trainers Leisure Coordinator Physiotherapists Occupational therapists Speech therapists Assessment Unit 40 places Vocational Training Unit 376 places Resources Centre Counselors Psychologists Social Workers Doctors Nurses UEROS (TBI) 20 places Dietetician Support Structures Technical and Accomodation Service, Human Resources, Accounting, Data Processing Service, Quality
General overview Functional Rehabilitation staff (pluridisciplinar approach) : 1 chief doctor, 1 care director, 6 doctors, 1 pharmacist, 3 care managers, 4 nurses managers, 40 nurses, 31 auxiliary nurses, 19 physiotherapists, 12 occupational therapists, 4 sport trainers, 3 psychologists, 3 social workers, 1 speech therapist, 1 psychomotor, 6 administrative staff Rehabilitation Programmes : cardiac physical effort retraining group (outpatient) spinal cord injuries group (inpatient and outpatient) brain injured group (TBI, vascular cerebral accident) (inpatient and outpatient) orthopaedics traumatology rheumatology group (inpatient and outpatient)
Functional unit repartition Inpatient Service Capacity Observations Rehabilitation of physical injury group 31 beds Rehabilitation of brain injured group 24 beds Rehabilitation of spinal cord injuries group 26 beds Outpatient Alternative for hospitalisation 46 places (about 80 people per day) 28 places for orthopaedics traumatology rheumatology group 12 places cardiac physical effort retraining group 6 places for COMETE (programme of early intervention for employment )
Average duration of the programmes Average Duration of hospitalization (inpatients) is 49 days in 2008 (51 in 2007). 130 DMS en Hospitalisation Complète (en nombre de jour) 174 91 100 23 27 2007 2008 87 Médullaire Cérébro-lésé Orthopédietraumatologie Comète
Number of clients (inpatients) Number of admissions Inpatients ( HC) Rehabilitation of spinal cord injuries group Rehabilitation of brain injured group Rehabilitation of physical injury group Comete programme early intervention for employment TOTAL 2007 59 36 319 4 418 2008 74 74 294 1 443
Number of clients (outpatients) Number of admissions Outpatients ( HDJ) Rehabilitation of spinal cord injuries group Rehabilitation of brain injured group Rehabilitation of physical injury group Cardiac physical effort retraining Comete programme early intervention for employment TOTAL 2007 96 106 345 225 45 817 2008 103 143 341 221 43 851
Number of days of hospitalization Compulsory agreement with the ARH (Regional Hospital Agency) Target fixed in 2008 Realized in 2008 Difference in % related to the CPOM Inpatients 20 833 21 896 +5 % Outpatients 18 000 16 662-7 %
Rate of occupation Inpatients Taux d'occupation en hospitalisation complète (en %) 85 75 65 72 82 69 Médullaire Cérébro-lésé Outpatient s Taux d'occupation en hospitalisation de Jour (en %) 38 61 134 139 112 92 90 46 47 124 Médullaire Cérébro-lésé Orthopédietraumatologie Orthopédietraumatologie Cardio rééducation 2007 2008 2007 2008 Comète Rate calculated on the basis of the days invoiced, without the therapeutic weekends
Funding Functional Rehabilitation financed by the French Public Welfare System Global funding per year : 9,7 millions of euros in 2008 ( VET 13,7 millions of euros) Average 250 euros / inpatient / day New law : funding related to the activity (T2A) produced (coding of medical and paramedical act - PMSI, data capture by the professionals) Progressive implementation starting in 2009 (final deadline 2012)
National context (1/2) Rehabilitation care (SSR) participates to the care process after acute care in hospital (MCO) Authorization delivered by the ARH (Regional Hospital Agency) 1700 establishments, 100 000 beds, average duration of hospitalization 28 days, a lot of little structures, average 65 beds Private profit sector (30%), public sector (40%), private organisations that participate to the public sector (30%) 75 establishments in Alsace en 2009, multi and specialized activities
National context (2/2) Increase of the demand (elderly people) Decree of 17 April 2008 applicable for the activity of SSR (new orientations, new authorizations, included elderly people, development of networks) To foster development of networks (rehabilitation of superior limb with the hospital of Diaconat, support of the pain )
Benefit of functional rehabilitation patient : to get back autonomy and to develop functional capacities, to lead to family and/or social reintegration, to increase quality of life Funder / community : to lead to a family, social and professional reintegration in the best conditions and as soon as possible
List of expected and desiderated outcomes set of indicators : the Ferrari of the CRM!
List of expected outcomes ex : rate of satisfaction of the patients Taux de réponse des patients par semestre depuis 2004 Nbre 700 100,0 % 600 80,0 500 400 300 41,7 50,0 45,5 50,1 48,4 56,1 49,8 52,9 51,6 60,0 37,9 40,0 Nb questionnaires enregistrés Nb personnes sorties 200 Taux de réponse 100 20,0 0 0,0 1 sem 04 2 sem 04 1 sem 05 2 sem 05 1 sem 06 2 sem 06 1 sem 07 2 sem 08 1 sem 08 2 sem 08
List of expected outcomes ex : rate of satisfaction of the patients % 100,00 Indice de satisfaction des patients à la sortie 99,50 99,00 98,50 98,00 97,50 97,00 96,50 96,00 95,50 95,00 1er sem 2004 2ème sem 2004 1er sem 2005 2ème sem 2005 1er sem 2006 2ème sem 2006 1er sem 2007 2ème sem 2007 1er sem 2008 2ème sem 2008 Pourcentage satisfaction globale
List of expected outcomes ex : number of the falls Chutes annuelles 90 80 70 60 50 40 30 20 10 0 82 75 Nbre 16 36 31 14 14 11 2005 2006 2007 12 2008 2009 10 Chutes 2006-2007-2008-2009 12 9 10 9 8 9 9 8 6 7 7 7 7 6 6 5 5 5 4 4 5 5 5 5 4 5 4 3 3 2 3 32 3 3 3 3 1 1 2 1 1 0 0 0 0 0 0 0 0 0 0 janv févr mars avr mai juin juil août sept oct nov déc Chutes 2006 Chutes 2007 Chutes 2008 Chutes 2009
Assessment approach of HAS HAS : French National Authority of Health Obligation of an certification procedure since 1996 for the 3500 French establishments Certification every 4 years (last certification in 2006, next in 2010) Heavy procedure Publication of the results on website of the Ministry of Health Generalisation of an indicator collection (11) in the V2010 certification procedure and 5 for SSR at the end of 2009
List of implemented indicators ICALIN : indicator of nosocomial infections ICSHA : consummation of hydro alcoholic products (process of hands washing) ICATB : indicator for the use of antibiotics Integrated in the V2010 certification procedure Other indicators on ongoing development Comparison between establishments by the ministry of Health (ARH) even by the local the media consommation des antibiotiques en DDJ (dose définie journalière) 2006 2007 2008 ICATB annuel DDJ 8,75 / 20 12,5/20 12,5 / 20 ICALIN Tableau des infections nosocomiales annuel indice composit e 67,5 C (en 2004) 89,5 A 91 A 90 A 92 A consommation SHA en litres pour Benchmarking ICSHA in Medical 1000 journées Rehabilitation d'hospitalisation 08-10 June 2009 annuel litres / 1000 jours 56 pour 2005 2,7 pour 1000 jours 18,1 % classe D 66 l pour 1000 jours 21,1% classe D 47 l pour 1000 jours 14,7% classe D 363 l
Benefits of Medical Rehabilitation not being measured Patients : different factors of Quality of life ==> self confidence, wellness, social insertion, sociability, insertion in the community