Measuring the fluidity of stroke patients flow between Acute Care (AC) unit and Rehabilitaiton Center.
Dr Jean DELATEa, Dr Michel ENJALBERTb, Mrs Morgane DI DOMINICOc, Mrs Céline AUDEFROYb, Prof Jacques PÉLISSIERc
a Cellule de coordination SSR et HAD. Languedoc-Roussillon. CHU Carémeau, b Cellule de coordination SSR et HAD. Languedoc-Roussillon. CH Perpignan, c Cellule de coordination SSR et HAD. Languedoc-Roussillon. CHU Carémeau Nîmes
Objective. To analyze the fluidity of the flow of stroke patients moved or transferred from the acute care (AC) units (including the Neuro-vascular unit) towards a rehabilitation center (RC) of the same territory. To compare so the stroke patients flow between two similar territories (T1 and T2).
Method. Data analysis of Via Trajectory (VT) and inpatient data (PMSI) concerning the flows of stroke patients in two territories of similar size (283000 and 233000 inhabitants respectively) and demographic characters by using the function Observatory of VT: rate of resort to RC (RR-RC), the % of admission RC / requests from AC ( % A-RC /R-AC), period (day) between the initialization of the request from AC / date of entrance in AC ( IR), period between the sending of the request from AC / wished entrance in RC ( SR-AC / WE-RC), period between AC admission/RC entrance (AC-A/RC-E). Type of rehabilitation center receiving the patients.
Results. Data from 01/01 to 12/31/2013. Population of stroke patients: T1=837 et T2=991, with a RR-RC in 38.82% (T1) and 50.85% (T2)(p<0.05) and % A-RC /R-AC in 65%(T1) and 84%(T2) (p<0.05). Periods (day): IR = 0.2(T1) et 0.3(T2) (NS); SE-AC / WA-RC = 4(T1) et 3.7(T2) (NS), SR-AC / WA-RC= 10.8(T1) et 3.2 (T2) (p<0.02) ; AC-A/RC-E = 24.4(T1) et 13.8 (T2) (p<0.02). Same level of dependency. Level of specialized neuro-rehabilitation center 36%(T1) and 67%(T2) with an offer of 16 RC in T1 including 1 neuro-rehabilitation center in T1 and 21 with 6 neuro-rehabilitation centers in T2.
Discussion/Conclusion. The Acute Care (AC) units (neurology including neuro-vascular unit) and Rehabilitation Centers are equally reactive. in patients management. The delay of entrance in RC is longer in T1 than in T2, and consequently the length of stay in AC is longer in T1 than in T2; the weakest resort to RC and especially to neuro-rehabilitation center (RC) in T1 compared with T2, is due to the weaker offer of RC beds in T1/T2, especially in neuro-rehabilitation. That should lead to a thought on distribution of the means between territories to insure the fluidity of the flow of stroke patients.
Keywords : Care pathways, stroke, coordination, rehabilitation care