Changes in Stroke Rehabilitation Outcomes After the Implementation of Japan’s Long-Term Care Insurance System:

Miyoshi, Yuta; Teraoka, Jeffrey K.; Date, Elaine S.; Kim, Mi Jung; Nguyen, Rosalyn; Miyoshi, S.

doi:10.1097/01.phm.0000171007.76831.01

Cited by 4 publications

(2 citation statements)

References 13 publications

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“…Older people with certified LTCI service needs can utilize facility services, in-home services, and community-based services. Following its implementation, the mean length of stay for patients with stroke in rehabilitation hospitals decreased ( 24 ). Furthermore, the Japanese government proposed establishing a community-based integrated care system by 2025 to comprehensively provide health care, nursing care, preventive care, housing, and livelihood support for patients ( 25 ).…”

Section: Chronic Phasementioning

confidence: 99%

Transitional and Long-Term Care System in Japan and Current Challenges for Stroke Patient Rehabilitation

et al. 2022

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In Japan, the national medical insurance system and long-term care insurance (LTCI) system cover rehabilitation therapy for patients with acute, convalescent, and chronic stroke. Medical insurance covers early and multidisciplinary rehabilitation therapy during acute phase hospitalizations. Patients requiring assistance in their activities of daily living (ADL) after hospitalization are transferred to kaifukuki (convalescent) rehabilitation wards (KRW), which the medical insurance system has also covered. In these wards, patients can receive intensive and multidisciplinary rehabilitation therapy to improve their ADL and transition to a smooth home discharge. After discharge from these hospitals, elderly patients with stroke can receive outpatient (day-care) rehabilitation and home-based rehabilitation using the LTCI system. The Japanese government has proposed building a community-based integrated care system by 2025 to provide comprehensive medical services, long-term care, preventive care, housing, and livelihood support for patients. This policy aims to promote smooth coordination between medical insurance services and LTCI providers. Accordingly, the medical insurance system allows hospitals to receive additional fees by providing patient information to rehabilitation service providers in the LTCI system. A comprehensive database on acute, convalescent, and chronic phase stroke patients and seamless cooperation between the medical care system and LTCI system is expected to be established in the future. There are only 2,613 board-certified physiatrists in Japan, and many medical schools lack a department for rehabilitation medicine; establishing such a department at each school is encouraged to teach students efficient medical care procedures, to conduct research, and to facilitate the training of personnel in comprehensive stroke rehabilitation.

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Section: Chronic Phasementioning

confidence: 99%

Transitional and Long-Term Care System in Japan and Current Challenges for Stroke Patient Rehabilitation

et al. 2022

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“…Patients can receive long-term services based on a certificate that states the need for long-term care in accordance with their activities of daily living (10) , (11) . Indeed, in Japan, after being discharged from acute and rehabilitation hospitals where the medical insurance system is applicable, patients with stroke can generally receive long-term rehabilitation (home-based and ambulatory) using the long-term care insurance system (12) , (13) , (14) , (15) .…”

Section: Introductionmentioning

confidence: 99%

Association between Care-need Level after Discharge and Long-term Outcomes in 7491 Patients Requiring Rehabilitation for Stroke

2024

JMA J

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Introduction: Stroke is a major cause of disability and mortality worldwide and requires long-term care, including rehabilitation. This study aims to elucidate the association between care-need levels after discharge and long-term outcomes in patients with stroke. Methods: We used a Japanese administrative database that covers both medical and long-term care insurance systems to retrospectively identify 7491 patients who underwent acute-phase in-hospital rehabilitation for stroke between June 2014 and February 2019. We investigated the association between nationally standardized care-need levels (support levels 1-2 and care-need levels 1-3) 6 months after discharge and long-term outcomes. Using the Fine-Gray model, we conducted multivariable survival analysis with adjustment for patient backgrounds and treatment courses to estimate hazard ratios (HR) for mortality and the incidence of being bedridden. Results: The median age was 82 (interquartile range [IQR], 76-87) years, 5418 patients (72%) had cerebral infarction, and 4009 patients (54%) had partial dependence after discharge. During a median follow-up of 580 (IQR, 189-925) days, 1668 patients (22%) became bedridden, and 2174 patients (29%) died. Compared with patients with support level 1, those with higher care-need levels showed significantly higher proportions of being bedridden―the subdistribution HR [95% confidence interval] were 1.52 [1.10-2.12], 2.85 [2.09-3.88], and 3.79 [2.79-5.15] in those with care-need levels 1, 2, and 3, respectively. Higher care-need levels were also significantly associated with higher mortality. Conclusions: This large-scale observational study demonstrated that a higher level of care-need after discharge was significantly associated with poorer functional outcomes and higher mortality.

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Revisiting Length of Stay in Stroke Rehabilitation in Turkey

Ozyemisci-Taskiran

Günendi

Aknar

et al. 2011

Archives of Physical Medicine and Rehabilitation

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Changes in Stroke Rehabilitation Outcomes After the Implementation of Japan’s Long-Term Care Insurance System:

Cited by 4 publications

References 13 publications

Transitional and Long-Term Care System in Japan and Current Challenges for Stroke Patient Rehabilitation

Transitional and Long-Term Care System in Japan and Current Challenges for Stroke Patient Rehabilitation

Association between Care-need Level after Discharge and Long-term Outcomes in 7491 Patients Requiring Rehabilitation for Stroke

Revisiting Length of Stay in Stroke Rehabilitation in Turkey

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