Makoto Tokunaga, MD, PhD, Susumu Watanabe, MD, PhD, Tadashi Terasaki, MD,
Tomohiro Takita, MD, Toshiro Yonehara, MD, PhD, Toru Nishi, MD, PhD,
Chikayoshi Kanazawa, MD, Shinichi Kawano, MD, PhD, Koreaki Yamakuma, MD,
Makio Yamaga, MD, PhD, Yoichiro Hashimoto, MD
Jpn J Compr Rehabil Sci 4: 88-96, 2013
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.
Key words: Nichijo-seikatsu-kino-hyokahyo, outcome measures, return home rate, gain, severity distribution