CHANGES IN FUNCTIONAL OUTCOME IN INPATIENT STROKE REHABILITATION RESULTING FROM NEW HEALTH-POLICY REGULATIONS IN ITALY

This study was designed to assess whether enforcement of new health po licy regulations in Italy limiting fully paid hospital stay to 60 days has actually caused a decrease in rehabilitation outcomes of stroke p atients. Final sample included 370 out of 398 consecutive patients hos pitalized between 1993 and 1996 for first stroke sequelae. Rehabilitat ion results were compared between subgroups of patients admitted befor e and after new Italian regulations. Length of stay was significantly (p < 0.001) shorter in 1996 than in previous years. However, between 1 993 and 1996 a significant (p < 0.05) decrease in effectiveness on mob ility and a significant (p < 0.05) increase in ''low responders'' on b oth daily living activities and mobility was observed. Moreover, in 19 95-96 the precocious discharge of patients compromised stabilization o f recovery with subsequent functional worsening. After discharge, outp atient rehabilitation treatment was able to conserve achieved mobility status, but not functional status on daily living activities. We sugg est revising the present regulation for medical rehabilitation service s to one based on FRGs (functional related groups), so that the approp riate treatment can be carried out for each patient.