The State of Orthopaedic Rehabilitation in Australia, 2005 APHA Congress, 2006 Frances Simmonds, Manager, Australasian Rehabilitation Outcomes Centre 11 October 2006
Introduction Rehabilitation is concerned with the diagnosis, evaluation and treatment of persons with limited function as a consequence of disease, injury, impairment and/or disorder AROC was formed in July 2002 with its principle objective being the collection of data against each and every rehabilitation episode provided in Australasian rehabilitation facilities AROC is auspiced by the AFRM, and operated within the Centre for Health Service Development at the University of Wollongong The AROC database now contains data describing more than 250,000 episodes of rehabilitation, and is therefore a rich source of information
AROC Coverage There are approximately 140 rehabilitation units in Australia, 80 public sector and 60 private sector units 123 submitted data to AROC in the 2005 calendar year (66 public sector units, 57 private sector units) In 2005 data describing 44,813 episodes was submitted to AROC. Of these episodes almost 45% (~20,000) related to orthopaedic rehabilitation AROC provides analysis of each individual member facilities data for that member, and also compares that data to analysis of the overall sector (public or private), and to the national data.
Episodes by impairment group, 2005 50 45 40 35 30 25 20 15 10 5 0 Stroke Brain Neuro Spine Amputee Arthritits Pain Ortho Cardiac Pulmonary Burns Congenital Other MultTrauma Developmental Debility Percentag
Episodes by impairment group, by sector, 2005 50 Public Private 40 30 20 10 0 Stroke Brain Neuro Spine Amputee Arthritits Pain Ortho Cardiac Pulmonary Burns Congenital Other MultTrauma Developmental Debility Percentag
Orthopaedic episodes as a percentage of all episodes, 2000-2005 50 45 Percentage of all impairm 40 35 30 25 20 15 10 5 0 2000 2001 2002 2003 2004 2005
Outcomes in Rehabilitation The Functional Independence Measure (FIM) is the most commonly used tool for the assessment of function in rehabilitation Function of a patient is assessed at admission and at discharge The difference between these two scores is called the FIM change and measures the degree of functional improvement achieved by the rehabilitation program FIM Change can then be divided by LOS to give FIM efficiency Discharge destination is another important outcome ideally a patient should be able to return to their previous form of accommodation, most often home
Outcomes in Rehabilitation Outcomes in rehabilitation cannot be measured by any single measure. It is the combination of elements that tell the story Admission FIM FIM change LOS Discharge destination Age and co-morbidities also add context. Rehabilitation episodes are categorised by the AROC impairment code Episodes can also be categorised by AN-SNAP class, the sub-acute sector s version of casemix
AROC Impairment Codes - orthopaedic 8.11 Unilateral hip fracture 8.12 Bilateral hip fracture 8.2 Femur (shaft) fractur 8.3 Pelvis fracture 8.4 Major multiple fracture 8.51 Unilateral hip replacement 8.52 Bilateral hip replacement 8.61 Unilateral knee replacement 8.62 Bilateral hip replacement 8.71 Knee and hip replacements (same side) 8.72 Knee and hip replacements (different sides) 8.9 Other orthopaedic
AN-SNAP classes - orthopaedic Class 223 Orthopaedic conditions, motor 74-92 Class 224 Orthopaedic conditions, motor 58-73 Class 225 Orthopaedic conditions, motor 52-57 Class 226 Orthopaedic conditions, motor 14-51
Overall Rehabilitation Outcomes Summary - change in measures 2000-2005 Difference from 2000 data -7.0-5.0-3.0-1.0 1.0 3.0 5.0 7.0 9.0 Disch usual accom (%) FIM efficiency (per week) FIM change (adm to disch) FIM discharge score FIM admission score Length of stay (day s) Age (y ears) -7-5 -3-1 1 3 5 7 9 Lower than 2000 data Higher than 2000 data
Orthopaedic Rehabilitation Outcomes Summary - change in measures 2000-2005 Difference from 2000 data -7-5 -3-1 1 3 5 7 9 Disch usual accom (%) FIM efficiency (per w eek) FIM change (adm to disch) FIM discharge score FIM admission score Length of stay (day s) Age (y ears) -7-5 -3-1 1 3 5 7 9 Lower than 2000 data Higher than 2000 data
Orthopaedic Rehabilitation volume changes by category over time
Orthopaedic episodes by group, 2005 7,000 6,000 Number of episodes 5,000 4,000 3,000 2,000 1,000 0 2000 2001 2002 2003 2004 2005 Fracture - hip Fracture - femur, pelv is, multiple Replacement - hip Replacement - knee Other orthopaedic
Public orthopaedic episodes by group, 2005 4,500 4,000 3,500 Number of episodes 3,000 2,500 2,000 1,500 1,000 500 0 2000 2001 2002 2003 2004 2005 Fracture - hip Fracture - femur, pelv is, multiple Replacement - hip Replacement - knee Other orthopaedic
4,500 4,000 3,500 Private orthopaedic episodes by group, 2005 Number of episodes 3,000 2,500 2,000 1,500 1,000 500 0 2000 2001 2002 2003 2004 2005 Fracture - hip Replacement - hip Other orthopaedic Fracture - femur, pelv is, multiple Replacement - knee
Number of episodes 10,000 9,000 8,000 7,000 6,000 5,000 4,000 3,000 2,000 1,000 0 2000 2001 2002 2003 2004 2005 223 224 225 226 Orthopaedic episodes by AN-SNAP class, 2005
Public orthopaedic episodes by AN-SNAP class, 2005 7,000 6,000 Number of episodes 5,000 4,000 3,000 2,000 1,000 0 2000 2001 2002 2003 2004 2005 223 224 225 226
Private orthopaedic episodes by AN-SNAP class, 2005 7,000 6,000 Number of episodes 5,000 4,000 3,000 2,000 1,000 0 2000 2001 2002 2003 2004 2005 223 224 225 226
Orthopaedic Rehabilitation Outcomes by Category, by Sector, 2005
Indicator & outcome measures all orthopaedic Difference from National data -15-10 -5 0 5 Disch usual accom (%) FIM efficiency (per week) FIM change (adm to disch) FIM discharge score FIM admission score Length of stay (days) Age (years) Private Public -15-10 -5 0 5 Lower than National data Higher than National data Proportion of episodes (n=19,455)
Indicator & outcome measures hip fracture Difference from National data -7-5 -3-1 1 3 5 7 9 Disch usual accom (%) FIM efficiency (per week) FIM change (adm to disch) FIM discharge score FIM admission score Length of stay (days) Age (years) Private Public -7-5 -3-1 1 3 5 7 9 Lower than National data Higher than National data Proportion of episodes (n=2,813)
Indicator & outcome measures - femur, pelvis & multiple Difference from National data -11-9 -7-5 -3-1 1 3 5 7 Disch usual accom (%) FIM efficiency/week FIM change FIM discharge FIM admission Length of stay Average age -11-9 -7-5 -3-1 1 3 5 7 Private Public Lower than National data Higher than National data Proportion of episodes (n=1,922)
Indicator & outcome measures hip replacement Difference from National data -15-13 -11-9 -7-5 -3-1 1 3 5 Disch usual accom (%) FIM efficiency (per week) FIM change (adm to disch) FIM discharge score FIM admission score Length of stay (days) Age (years) Private Public -15-13 -11-9 -7-5 -3-1 1 3 5 Lower than National data Higher than National data Proportion of episodes (n=4,219)
Indicator & outcome measures knee replacement Difference from National data -16-14 -12-10 -8-6 -4-2 0 2 4 Disch usual accom (%) FIM efficiency (per week) FIM change (adm to disch) FIM discharge score FIM admission score Length of stay (days) Age (years) Private Public -16-14 -12-10 -8-6 -4-2 0 2 4 Lower than National data Higher than National data Proportion of episodes (n=4,674)
Indicator & outcome measures other orthopaedic Difference from National data -14-12 -10-8 -6-4 -2 0 2 4 Disch usual accom (%) FIM efficiency (per week) FIM change (adm to disch) FIM discharge score FIM admission score Length of stay (days) Age (years) Private Public -14-12 -10-8 -6-4 -2 0 2 4 Lower than National data Higher than National data Proportion of episodes (n=5,827)
But one could say that looking at the data by category is not fair, because it doesn t take into account degree of difficulty, or resource use so let s have a look at the same data by AN-SNAP class
Indicator & outcome measures - AN-SNAP class 226 Difference from National data -9-7 -5-3 -1 1 3 5 7 Disch usual accom (%) FIM efficiency (per week) FIM change (adm to disch) FIM discharge score FIM admission score Length of stay (days) Age (years) -9-7 -5-3 -1 1 3 5 7 Private Public Lower than National data Higher than National data Proportion of episodes (n=4,423)
Indicator & outcome measures - AN-SNAP class 225 Difference from National data -12-10 -8-6 -4-2 0 2 4 6 Disch usual accom (%) FIM efficiency (per week) FIM change (adm to disch) FIM discharge score FIM admission score Length of stay (days) Age (years) -12-10 -8-6 -4-2 0 2 4 6 Private Public Lower than National data Higher than National data Proportion of episodes (n=2,702)
Indicator & outcome measures - AN-SNAP class 224 Difference from National data -15-13 -11-9 -7-5 -3-1 1 3 5 Disch usual accom (%) FIM efficiency (per week) FIM change (adm to disch) FIM discharge score FIM admission score Length of stay (days) Age (years) -15-13 -11-9 -7-5 -3-1 1 3 5 Private Public Lower than National data Higher than National data Proportion of episodes (n=8,818)
Indicator & outcome measures - AN-SNAP class 223 Difference from National data -12-10 -8-6 -4-2 0 2 4 Disch usual accom (%) FIM efficiency (per week) FIM change (adm to disch) FIM discharge score FIM admission score Length of stay (days) Age (years) -12-10 -8-6 -4-2 0 2 4 Private Public Lower than National data Higher than National data Proportion of episodes (n=3,376)
Overall Observations The unadjusted data shows that: LOS is usually longer in the public sector but patients are usually older (except for hip fractures) and have lower FIM admission scores (? influence of funding models) FIM change achieved is greater in the public sector.. in all but non-hip fractures Private sector achieves a slightly higher FIM efficiency Private sector also discharges to home more frequently Interestingly, when the data is casemix adjusted the story does not change very much: LOS is still longer in the public sector, but patients are still older and have lower FIM admission scores However, FIM change achieved is now greater in the private sector FIM efficiency still higher in the private sector Percentage patients discharged to home also still greater in the private sector
AROC Projects and Products Rehabilitation clinical indicator review Write up of annual State of the Rehabilitation Nation report Development of version 3 of the AROC data set, with implementation expected 1 July 2007, in line with SNAP classification review AROC Impairment Code review Development of AROC ambulatory dataset, with implementation expected 1 July 2007 DVA research project on models of rehabilitation care Impairment specific benchmarking workshops Process and outcome improvement workshops for individual facilities Ad hoc reports, as commissioned
AROC Contact Details Australasian Rehabilitation Outcomes Centre Building 29 University of Wollongong NSW 2522 Phone: 02-4221-4411 Email: aroc@uow.edu.au Web: www.uow.edu.au/commerce/aroc