Access to rehabilitation facilities in an unselected hospital population affected by acute stroke

Abstract

The aim of this study was to evaluate the selection criteria and characteristics of the patients who have access to rehabilitation facilities after having experienced an acute stroke. Between January 1993 and February 1994, 383 patients were recruited in 13 hospitals in Lombardy, and telephonically followed up four months after study entry. The data were collected by members of the Associazione Volontari Ospedalieri (Hospital Volunteers' Association). The 4-month mortality rate was 23%. The primary selection criterion for gaining access to rehabilitation facilities was the degree of disability; the secondary factor was age. Rehabilitation facilities were not available to very severely afflicted or self-sufficient patients, but were preferentially made available to young, partially-dependent patients. A rehabilitative intervention within the first month was made available to fewer than 50% of the patients for whom it was indicated. The absence of care for elderly patients and the delay in its availability for those who actually receive it underline the need for new organisational methods. The data presented here also show that voluntary associations can work as observers of the health service. A more complete study is required in order to understand the real dimensions of the problem and the clinical and social characteristics of the population involved.

Referral to Rehabilitation After Severe Traumatic Brain Injury

“…Most of these characteristics were related to discharge destination in other health care environments. 13,14,[18][19][20] Generalizability to other contexts of health care, particularly mixed-payer systems, is also not easy because the role of insurance type in similar studies 29 seems central. However, the present results suggest that social vulnerability influences medical decision making, even in a system that could a priori be assumed to minimize the effects of such factors by providing insurance coverage.…”

“…Few studies have reported information regarding access to inpatient rehabilitation for TBI patients. Most have shown that many patients did not receive any postacute rehabilitation [13][14][15][16] -as many as a quarter of severe TBI patients. 13 Moreover, only 16% of patients hospitalized for TBI of mixed severity were referred for specialized NR.…”