Objective : To investigate how rehabilitation outcomes improved after the rehabilitation plan was changed. Subjects : 54 patients that were admitted to a kaifukuki rehabilitation ward in a regional hospital from January 2007 to June 2007 and 679 patients that admitted from January 2008 to June 2011. Methods : We changed the rehabilitation plan as follows to improve rehabilitation outcomes. Physiatrists estimated the rehabilitation goal and the length of hospital stay (LOS) at the first examination. All patients had intensive rehabilitation with standing up exercises and ADL training toward the goal. LOS, Functional Independence Measure (FIM) gain, FIM efficiency and the percentage of patients discharged home during 6 months before the change were compared with those during the same period after the change. In stroke patients, hip fracture patients and deconditioned patients, the same comparison was performed. Results : In the 4 years after the change was initiated, LOS was reduced significantly from 96.5 days to 29.2 days (p<0.001). The change of FIM gain was not significant, but FIM efficiency increased significantly from 0.22 to 0.91 (p<0.001). The percentage of patients discharged home also increased significantly from 85.2% to 99.1% (p<0.001). Also in stroke patients and hip fracture patients, LOS was reduced and FIM efficiency was increased significantly. The sample of deconditioned patients was small, but their LOS was reduced significantly. Conclusion : The changed rehabilitation plan reduced LOS, increased FIM efficiency and enabled most patients to discharge home.

Objective：To assess the effects of increased financial incentives in medical fee revisions on acute rehabilitation quality by elucidating the changes in the timing and quantity of rehabilitation services provided after total knee arthroplasty.Methods：The analysis was conducted using nationwide Diagnosis Procedure Combination data from 2010 to 2017. Hospitals were divided into two groups (≥1,000 cases and＜1,000 cases), and the differences in basic characteristics, clinical findings/course, and rehabilitation practices were analyzed according to medical fee revision years. Multiple linear regression analyses were performed with the following dependent variables：duration before postoperative rehabilitation initiation and the number of rehabilitation therapy units provided. Independent variables included medical fee revision years and case volume.Results：Throughout the 8-year study period, there were reductions of 0.4 days (hospitals with ≥1,000 cases) and 1.3 days (hospitals with＜1,000 cases) before rehabilitation initiation. There were also significant increases in rehabilitation therapy units provided in the first 2two weeks after surgery. Earlier rehabilitation initiation was associated with case volume and medical revision year. Similarly, increases in rehabilitation therapy units were associated with case volume, medical revision year, and comprehensive rehabilitation plan evaluation fees.Conclusion：Higher reimbursements to hospitals, especially hospitals with＜1,000 cases, were associated with earlier rehabilitation interventions, and increased rehabilitation services provided within a short duration. These medical fee revisions appeared effective in raising the quality of acute rehabilitation therapy.

Objective：To assess the effects of increased financial incentives in medical fee revisions on acute rehabilitation quality by elucidating the changes in the timing and quantity of rehabilitation services provided after total knee arthroplasty.Methods：The analysis was conducted using nationwide Diagnosis Procedure Combination data from 2010 to 2017. Hospitals were divided into two groups (≥1,000 cases and＜1,000 cases), and the differences in basic characteristics, clinical findings/course, and rehabilitation practices were analyzed according to medical fee revision years. Multiple linear regression analyses were performed with the following dependent variables：duration before postoperative rehabilitation initiation and the number of rehabilitation therapy units provided. Independent variables included medical fee revision years and case volume.Results：Throughout the 8-year study period, there were reductions of 0.4 days (hospitals with ≥1,000 cases) and 1.3 days (hospitals with＜1,000 cases) before rehabilitation initiation. There were also significant increases in rehabilitation therapy units provided in the first 2two weeks after surgery. Earlier rehabilitation initiation was associated with case volume and medical revision year. Similarly, increases in rehabilitation therapy units were associated with case volume, medical revision year, and comprehensive rehabilitation plan evaluation fees.Conclusion：Higher reimbursements to hospitals, especially hospitals with＜1,000 cases, were associated with earlier rehabilitation interventions, and increased rehabilitation services provided within a short duration. These medical fee revisions appeared effective in raising the quality of acute rehabilitation therapy.