Australia, Finland, South Africa and the USA

comparison of service delivery and outcomes in rehabilitation for spinal cord dysfunction

Overview
Who are we? What did we set out to do? Why is this important? How did we go about it? What did we find? Did it make sense? Whats next?

Who are we?

International Rehabilitation Outcomes Network (IRON)
Janette Green, Rob Gordon, Ben Marosszeky
Australasian Rehabilitation Outcomes Centre

Helena Valvanne-Tommila, Pekka Paunio

Qualisan Ltd in Finland,

Hennie Loubser, Belinda Richards

South African Database for Functional Medicine

Sam Fleming
AOD, Inc in the USA

What did we set out to do?

Improvement of services for patients aided by benchmarking within a country. Question is.How do we compare between countries (apples vs apples?) and what can we gain? Our aim. using data on rehabilitation for patients with spinal cord injury from 4 countries:
identify similarities and differences in outcomes identify similarities and differences in service delivery to help understand the results

Why is this important? (1)

Effective rehabilitation means

patients return home with high level of functional independence reducing social and financial costs to the patient, the health care system and the broader community.

Why is this important? (2)

Spinal cord injury - high cost with long LOS and repeat episodes, life-long care Low volumes limit comparisons within a country International comparisons may lead to improvements in service delivery

How did we go about it?

Similar datasets in all four countries Clinical and demographic information Collected between 1998 and 2006 Differences in number of patients and number of facilities

Number of
Number of Number of facilities episodes 81 3464 15 1628 13 396 147 9847

Country Australia Finland South Africa USA

What did we find?

Differences in data
length of stay (LOS) from 20 days in the US to 69 days in South Africa functional gain (using the 18-item FIMTM) from 6 points in Finland to 26 points in South Africa function on admission and discharge discharge destination (72% - 79% discharged home)

Differences in casemix, including age Differences in provision of services

Looking at the casemix (1)

Spinal injuries can be non-traumatic or traumatic Non-traumatic injuries accounted for:
63% of the Australian data 49% of the Finnish data 40% of the South African data 70% of the US data

Age distribution Non-traumatic SCI

100% 90% 80% 70% 60% 50% 40% 30% 20% 10% 0%

Australia-Non Traumatic

Finland-Non Traumatic

South Africa-Non Traumatic

USA-Non Traumatic

0-14

15-29

30-49

50-64

over 64

Age distribution Traumatic SCI

100% 90% 80% 70% 60% 50% 40% 30% 20% 10% 0%

AustraliaTraumatic 0-14

Finland-Traumatic 15-29 30-49

South AfricaUSA-Traumatic Traumatic 50-64 over 64

Looking at the Casemix (2)

Para-incomplete Para-complete Non-Traumatic Quad-incomplete Quad-complete Other Para-incomplete Para-complete Quad-incomplete Quad-complete Australia Finland South Africa 14% 16% 14% 6% 4% 7% 6% 11% 3% 2% 1% 3% 13% 6% 3% 6% 7% 9% 4% 34% 9% 7% 17% 5% 24% 8% 26% 8% 9% 18% USA 11% 1% 6% 0% 49% 3% 3% 7% 3% 15%

Traumatic

Not specified at this level

Looking at the casemix (3)

AN-SNAP (Version 2) Classes for Spinal Cord Dysfunction
S2-220 S2-221 S2-222 S2-223 S2-202 FIM Motor 81-91 FIM Motor 47-80 FIM Motor 14-46, Age >=33 FIM Motor 14-46, Age <=32 Brain, Neuro, Spine, MMT, FIM=13

Percentage in each AN-SNAP Class

100% 90% 80% 70% 60% 50% 40% 30% 20% 10% 0%

Australia

Finland

South Africa

USA

S2-202

S2-223

S2-222

S2-221

S2-220

LOS Non-Traumatic SCI

90% 80% 70% Percentage 60% 50% 40% 30% 20% 10% 0%
0 - 19 20 - 39 40 - 59 60 - 79 80 - 99 100 - 119 120 - 139 140 - 159

Country
Aust Finland SA USA

Average LOS (days)

37 28 64 16

Length of Stay (days)

Australia

Finland

South Africa

USA

Function on admission and at discharge Non-Traumatic SCI

110
Functional independence score

100 90 80 70 60 50 Non-Traumatic Admit Australia Finland

Impairment

Non-Traumatic Discharge South Africa USA

LOS Traumatic SCI

60% 50% 40% 30% 20% 10% 0%
0 - 19 20 - 39 40 - 59 60 - 79 80 - 99 100 - 119 120 - 139 140 - 159

Country
Aust Finland SA USA

Average LOS (days)

70 35 72 29

Percentage

Length of Stay (days)

Australia

Finland

South Africa

USA

Function on admission and at discharge Traumatic SCI

100 95
Functional independence score

90 85 80 75 70 65 60 55 50 Traumatic Admit Australia Finland

Impairment

Traumatic Discharge South Africa USA

Did it make sense?

Australia, rehab starts in acute care
rehab designated units including special units outpatient & community services may follow

Finland, rehab follows acute care

treatment in specialist spinal unit after acute episode life-long follow-up, outpatient or inpatient

South Africa, rehab follows acute care

data includes ICU, rehab and subacute units.

USA, rehab starts in acute care

outpatient and other inpatient options for patients

Whats next?
More analysis on individual functional items Closer examination of specific processes BUT ALREADY. We have shown that international collaboration and data-sharing is possible
when similar information is collected with similar definitions we are able to speak a common language to provide useful world-wide guidelines and standards for best-practice rehabilitation.