Hasil sebuah penelitian pada pencegahan stroke, Tim Peneliti menemukan bahwa rata-rata biaya stroke di Amerika Serikat

pada tahun 1991 adalah 15 ribu dolar. Total biaya stroke menjadi 30 juta dolar jika pembiayaan secara tidak langsung dari produktivitas dan kinerja were considered. Analisis Praktek Multivariate ada sedikit informasi yang diterbitkan pada pola pemanfaatan layanan kesehatan pasien stroke.

sebagai bagian dari Pedoman AHCPR sebuah Medicare klaim analisis data dilakukan seperti dijelaskan di atas, dan menemukan variasi praktek yang signifikan dalam akses ke, pemanfaatan, dan biaya pelayanan pos rehabilitasi stroke.
Akses ke pelayanan rehabilitasi akses fisik ke layanan rehabilitasi hanya dapat diukur dari ketersediaan tempat tidur IRH dan NF. Ada variasi yang signifikan dalam distribusi geografis dari tempat tidur. Penggunaan Pelayanan Rehabilitasi kebanyakan pasien stroke yang menerima pengobatan lebih dari satu posting-akut pengaturan (misalnya di-pasien rehabilitaion dan layanan kesehatan rumah rehabilitasi berikutnya). tabel berikut menunjukkan pemanfaatan nasional overail pasca layanan rehabilitasi stroke yang dihitung dari tahun 1991 data klaim Medicare. ini adalah rata-rata nasional. ada praktek variasi yang tidak dapat dijelaskan oleh perbedaan pasien (ketajaman, jenis stroke) atau faktor pasar (ketersediaan tempat tidur, dll). Berikut adalah beberapa contoh spesifik dari variasi geografis yang luas terlihat pada pasca stroke pemanfaatan: penerimaan ke rumah sakit rehabilitasi berkisar antara 8 persen dari penderita stroke di Nebraska menjadi 31 persen di Idaho Penerimaan ke NF (keperawatan fasilitas) berkisar antara 12 persen di distrik columbia menjadi 42 persen di Minnesota Penerima layanan kesehatan rumah berkisar antara 10 persen di North Dakota menjadi 62 persen di Vermont Penderita stroke yang tidak menerima pelayanan rehabilitasi berkisar dari 9 persen di Vermont menjadi 55 persen pada wyoming Biaya post stroke masing-masing pasien total biaya rata-rata per pasien pengobatan pasca stroke dalam interval enam bulan pasca stroke adalah 18.262 Dolar. stroke hemoragik memiliki rata-rata biaya total yang lebih tinggi ($ 27.842) dari stroke hemoragik non ($ 17,830). rata-rata diperkirakan indeks biaya masuk nasional adalah $ 7.870. Debit biaya pasca rata (termasuk readmissions akut berikutnya) adalah $ 10.755. Namun, ketika pelayanan rehabilitasi secara khusus diidentifikasi, dan perawatan medis mahal yang memerlukan pasien stroke yang dikurangi, maka rehabilitasi neraca jasa-jasa selama 14% dari pasca stroke biaya episode, atau $ 2.662 dari $ 18.262. Biaya per pasien bervariasi sebanyak 50% tergantung pada daerah layanan negara atau metropolitan di mana jasa diserahkan. contoh termasuk biaya pos debit rata-rata bervariasi dari $ 9.585 di Seattle untuk $ 21.634 di Oakland, pengakuan indeks biaya mulai dari $ 4.548 di Utah untuk $ 14.438 di Newark, NJ.

Tim Disiplin

salah satu pilar dasar perawatan rehabilitasi karena si dipraktekkan di Amerika Serikat saat ini adalah konsep pendekatan tim. tim interdisipliner terdiri dari beberapa individu dari berbagai latar belakang dengan tujuan yang sama untuk mengobati pasien dengan stroke untuk memungkinkan dia untuk memenuhi tujuan yang telah ditetapkan. interdisipliner (dibandingkan dengan multi-disiplin) membutuhkan pendekatan, terkoordinasi interaktif antara anggota tim ganda untuk umum, tujuan eksplisit. umumnya tim ini terdiri dari tim inti yang terdiri dari dokter, perawat, terapis fisik, terapis okupasi, terapi bicara, terapi rekreasi, dan pekerja sosial. umum, ahli gizi, psikolog, neuropsikolog, pelayanan pastoral, dan manajer kasus adalah anggota tim. berikut ini adalah sinopsis singkat dari pelatihan dan latar belakang pendidikan dari berbagai anggota tim. perhatian khusus diberikan kepada berbagai gradasi dalam e, disiplin tertentu. g. sebuah registerd PT versus ajudan PT.
Terapi fisik : Terapis fisik bekerja untuk meningkatkan mobilitas pasien, kekuatan, dan kondisi umum. Registerd physical therapist (RPT) have a bachelors of science (4 years of college) plus 6 month supervised internship and succesful completion of a professional certification examination by the american occupational theraphy certification boadr certified internship AOTCB). Certified occupational therapists assistans (COTA) have a 2 year associates degree, a 12 week supervised internship and a certifying examination by the AOTCB. Occupational therapy aides are trained by the institution in which they work and usually assist OTRs and COTAs. Speech-Language pathologist. The speech language pathologists (SLPs) work with patients with aphasia, cognitive-perceptual disorders, and dysphagia. Speech-language pathologists (SLPs) obtain a Certificate of Clinical Competence (CCC) from the American Speech-Language-Hearing Association (ASHA). They need a masters degree, 375 hours of supervised clinical observation, and a clinical Fellowship which consists of weeks of proffesional experience. Recreational therapy : Ther recreation therapists uses recreational activities to treat people with disabilities. Certification is offered by the National Council for Therapeutic Recreation Certification (NCTRC). Certified therapeutic recreation specialist (CTRS). Education consists of a baccalaureate degree with a major in therapeutic recreation or recreation. A 10 week field placement or 5 year work experience are required. Certified therapeutic recreation assistant (CTRA). Education consists of an associate degree with a major in therapeutic recreation or recreation. In addition a 10 week field placement may be required. Psychologist : The psychologist understands human behavior and treats the emotional and psychological issues and dysfunctions of the patient and family. Clinical psychologists complete a doctoral program as either a doctor of philosophy (Ph. D) or a doctor of psychology (Psy. D). Both require a one year internship following the doctoral degree. The neuropsychologist is a psychologist who emphasizes understanding and treatment of the psychological, behavioral and cognitive problems that occur with injury to the brain. Social Workers : understand human behavior, emotions, and social interactions they treat the patient and the family. They also have knowledge about and can facilitate obtaining concrete services needed by the patients. Social workers have a baccalaureate degree and a masters degreen in social work (MSW). If they are licensed in the state where they practice, they are designated LCSWs, that is licensed clinical social workers. They have a 1 2 year internship during their

schooling, and need 3000 hours of direct clinical practice before becoming eligible to take an examination to earn their LCSW. The physician on the rehabilitation team often functions as team leader and treats the medical and neurological problems and coordinates the care of consultants. Physiciatrists and neurologists are the most common specialties who have the training and experience to be rehabilitation physicians. Neurologists learn the workings of the nervous system and have a minimum of 3 years of residency completed a 3 year residency in PM&R. Rehabilitation nursing provide nursing services in a variety of settings to those patients with neurological problems. Registered nurses (RNs) have completed a 4-year college program in nursing , or a 2 or 3 year hospitol-based program in nursing, and have completed an examination by the state examining board. An RN with at least two years of rehabilitation nursing experience who has been examined and certified by the Rehabilitation Nursing Certification Board is called a Certified Rehabilitaion Registered Nurse (CRRN). Licensed vocational n nurses (LVNs) must have completed the 10th grade in high school and then undergo 1,600 hours of nursing practice and theory. The complete an examination administered by the state. Nurse aides receive training at institution in which they work to perform some nursing functions. Outcome measures Measurement of outcome is increasingly important in all areas of medicine, and rehabilitation is no exception. Simple positive outcomes after stroke, such as mortality and return to home are important end points. Figure 7 shows discharge disposition from our IRH acute stroke unit during the past twenty-two months (n=539). The vast majority of patientsn (77%) are discharged to home, and about 12% are transferred to the acute medical hostpital for medical complications such as DVT, penumonia, sepsis, chest pain, etc. While these are important end points, rehabilitation specialists have concetrated on functional agains in ADLs, mobility, and communication. The FIM or functional Independence Measure has been used extensively in rehabilitation. It was developed in 1986 by Carl Granger and others to allow for a uniform data set (UDS) for medical rehabilitation. FIM is an 18-item, seven level scale of independent performance in self-care, sphincter control, transfers locomotion, communication, and cognition. (Figure 8). It has been shown to be valid, reliable, and sensitive. In 1992 over 26,000 stroke patients in rehabilitation in 256 hospitals in 44 states were evaluated using the FIMs (Granger, 1994). The Mean age was of stroke patient was 71 y.o. and had a mean admission FIM of 62, with a mean discharge FIM of 86. FIM scores range from a minimum of 18 to a maximum of 126. Most patients with a score of > 80 can return to independent living. The average FIM gain per week was 6.0 with 76% of patients discharged to the community and 15% to longterm care facilities and 7% to acute medical hospitals. The efficiency or rehabilitation can be calculated using the change in FIM points over time .