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    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 Nebraskamenjadi 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.

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    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 adoctoral 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

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    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 amean 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 .