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A study of standard criteria for hospital admission fees using the Nichijo-seikatsu-kino-hyokahyo in Kaifukuki rehabilitation wards

Tokunaga T, Watanabe S, Terasaki T, Takita T, Yonehara T, Nishi T, Kanazawa C, Kawano S, Yamakuma K, Yamaga M, Hashimoto Y. A study of standard criteria for hospital admission fees using the Nichijo-seikatsu-kino-hyokahyo in Kaifukuki rehabilitation wards. Jpn J Compr Rehabil Sci 2013; 4: 88-96. Purpose: To consider methods, based on study results, which would allow the differences in severity distribution between hospitals to be reflected in the hospital admission fee standards, using the Nichijoseikatsu-kino-hyokahyo (NSKH). Methods: A sample of 3,389 patients with stroke was analyzed. Scores obtained from NSKH were divided into four categories: scores 0 to 4, 5 to 9, 10 to 14, and 15 to 19. The numbers of patients in the four categories, changes in NSKH score (NSKH gain), and the return home rates were computed for all the participating hospitals and for each of six and other hospitals. We calculated the adjusted NSKH gain and adjusted return home rate at each hospital, using a correction method based on the distribution of NSKH scores for patients in all the participating hospitals (the standard severity distribution). Results: The following differences were found between the hospitals. The percentage of patients identified as “critically ill” (with NSKH scores of 10 to 19) ranged from 29.4 to 44.8%. Patients with NSKH scores of 15 to 19 (severely critically ill patients) occupied 33.6 to 50.2% of the patients with NSKH scores of 10 to 19 (critically ill patients). The mean NSKH scores on admission ranged from 6.52 to 8.60, while the adjusted NSKH gain ranged from 2.23 to 3.50 points and the adjusted return home rates ranged from 58.3 to 74.3%. Conclusion: There may be a need to give higher evaluation to hospitals that show high mean NSKH scores at admission. In addition, adjustment by the standard severity distribution may have to be used in determining NSKH gain and the return home rate.