F-3-16-01
COMPREHENSIVE OUTPATIENT REHABILITATION FACILITY
Meeta D. Peer, M.D. (Neumann Medical Center, Philadelphia. PA)
Comprehensive outpatient rehabilitation facilities (CORFs) are becoming popular entities in rehabilitation practices in the U.S.A.
CORFs are established under federal government Medicare Part B to provide coordinated comprehensive rehabilitation services at one location in the U.S.A. Programs are set up in the CORF mainly for musculoskeletal and neuromuscular rehabilitation of patients as well as injured workers. A multidisciplinary approach is utilized in the management of patients as well as diagnostic procedures being performed by physicians in the facility. Services provides in the CORF setting include physiatrists' services, physical therapy, occupational therapy, speech therapy, respiratory therapy, orthotics, prostheses, nursing, psychological and social services.
Patients with different diagnoses are seen and evaluated in the CORF and accordingly, various programs are developed. Length of stay for acute and subacute inpatient programs are becoming progressively shorter in the U.S.A. where managed care has become critical in delivering cost effective healthcare in the last few years.
In conclusion, CORF provides an exciting form of practice in rehabilitation medicine with particular interest in long-term rehabilitation to maintain the patient's functional capabilities. In the U.S.A., the present structure of the CORF will increasingly become more of a focal point of rehabilitation in providing various rehab services to the communities.
F-3-16-02
A COST-BENEFIT ANALYSIS OF UTILIZATION OF ASSISTIVE TECHNOLOGY FOR HOME-BOUND DIS ABLED PEOPLE.
Tom Takaoka, Toshiyuki Ito, Hironobu Sashika, Maki Taguchi, Kaoru Saito (Yokohama Rehabilitation Center, Yokohama, Japan)
Going out to engage in activities such as seeing a movie or attending a meeting is an important factor in maintaining the quality of life for home-bound disabled people. To improve the accessibility of their home environment and to reduce the level of assistance required the city of Yokohama has financially supported these people, in purchasing assistive devices and remodeling their homes, since 1987. The purpose of this study was to estimate the care costs with and without assistive devices and related home remodeling. The subjects were 48 disabled people (average age; 59 yrs.) who had either wheelchair lifts or stair lifts installed in the 1995 fiscal year. For each subject the actual cost of the environmental improvements plus the estimated cost of required human assistance was compared to the estimated cost of human assistance without environmental improvements. The cost of human assistance was calculated based on the following assumptions: (1) the assistive device and the related home modification were equivalent to the assistance of two people; (2) the cost of a carer's assistance was equivalent to that of a skilled worker (\1,500/hr.); (3) the duration of the care assistance each time going out was two hours; (4) the frequency of going out is constant in each subject. The results indicated that in 25 of the 48 cases (52%) the cost of the environmental improvement with/without human assistance was expected to be lower than the cost of assistance only within 3 years and in 32 cases (67%) within 5 years. From our 1O-year experience in the outreach services it is apparent that the utilization of assistive technology is effective in increasing the frequency of going out and lessening caretaker's load. These results also revealed that utilization of assistive technology is practical from the view point of cost efficiency.
