| 제목 |
The Potential for Measuring Complex Rehabilitation Needs through a Bundled Payment Model |
| 소속 |
National Traffic Injury Rehabilitation Hospital, TBI rehabilitation center1, The Catholic University of Korea Seoul St. Mary`s Hospital , Department of Rehabilitation Medicine2, The Catholic University of Korea St. Vincent`s Hospital , Department of Rehabilitation Medicine3, Seoul National University Hospital, Department of Rehabilitation Medicine4, Inje University Ilsan Paik Hospital, Department of Rehabilitation Medicine5, The Catholic University of Korea Bucheon St. Mary`s Hospital , Department of Rehabilitation Medicine6, St. Paul Hospital, The Catholic University of Korea, Department of Rehabilitation Medicine7, Bobath Memorial Hospital, Department of Rehabilitation Medicine8, National Traffic Injury Rehabilitation Hospital, Department of Nursing9, National Traffic Injury Rehabilitation Hospital, Traffic Injury Rehabilitation Research Institute10, The Catholic University of Korea Eunpyeong St. Mary`s Hospital, Department of Rehabilitation Medicine11 |
| 저자 |
Tae-Woo Kim1,2†, Hoo Young Lee1,2*, Seong Hoon Lim3, Hyung-Ik Shin4, Jeehyun Yoo5, Sun Im6, Myung Eun Chung7, Soon Yong Kwon8, Hyun-Mi Oh1,2, Jihye Park11, Hyo Eun Kim9, Da Ban Lim10, Si Young Park10, Ji-Yeon Lee10 |
Background and Aim: Patient-centered rehabilitation services and continuum of care are major issues faced in the rehabilitation medical service delivery system in Korea. In particular, assessing the complexity of rehabilitation needs of patients in the intensive and comprehensive rehabilitation phase is a crucial component of gatekeeping system. Furthermore, efficient and effective management of resources is essential for success at a patient, system, and provider level. Under the current fee-for-service (FFS) payment system in Korea, rehabilitation services are compensated based on volume of services rather than on quality of care and outcomes. Currently, bundled care of value-based payment models is promoted to mend the current payment scheme. Under the bundled payment approach, a single payment is provided to multiple providers for a set of services related to an episode of care within a set time period. However, bundled payment pilot programs have not yet been implemented in practice in Korea. Therefore, the impact of payment schemes on the delivery of rehabilitation service remains unclear. The aim of this study was to investigate the potential impact of bundled payment on the rehabilitation medical service delivery system in Korea. Here, we validated the psychometric properties of the Korean version of Rehabilitation Complexity Scale version 1 through the bundled payment model and compared with the current FFS.
Methods: A cross-sectional, multicenter, pilot study, involving six designated rehabilitation medical institutions in Korea and 391 in-patients showing complex neurological or musculoskeletal problems was carried out. Two variables, number of therapy unit(Tu) and therapy unit intensity(Tui) provided as parts of the bundle were distinguished from the number of disciplines(Td) and therapy intensity(Ti) in original K-RCS-E. For Tu and Tui, rehabilitation doctors were asked to choose the content and intensity of rehabilitation practices and redesign care that optimizes the provision of valued services and eliminates services that add costs without offering meaningful benefits. The construct validity of the K-RCS-E was explored by exploratory factor analysis(EFA) and confirmatory factor analysis(CFA).
Results: The EFA under bundled payment approach indicated two different components by Nursing(N)-Care(C)-Medical(M) and Tu-Ti-Equipment(E) while FFS indicated them by M-N and Ti-Td-C-E. The results of the CFA demonstrated that the two-factor model by bundled payment had an excellent fit(Normed Fit Index(NFI)=0.95, Comparative Fit Index (CFI)=0.96) with the K-RCS-E scores assessed while the model fit indices by FFS are slightly less than the good fit(NFI=0.86, CFI=0.87).
Conclusion: Measuring complexity of rehabilitation needs by K-RCS-E through value-based care and payment schemes may provide an adjuvant case-mix measure to determine the rehabilitation setting and resources in the rehabilitation delivery system of Korea. |
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Therapy needs of Korean Rehabilitation Complexity Scale-Extended(K-RCS-E) by payment schemes.
Descriptive statistics of therapy needs by Korean Rehabilitation Impairment Category (KRIC)
Path diagram of the confirmatory factor analysis of the K-RCS-E in terms of payment schemes
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