The Australian National Sub-acute and Non-acute Patient Casemix Classification (AN-SNAP): its application and value in a stroke rehabilitation programme

Lowthian, Peter; Disler, Peter; Ma, Sam; Eagar, Kathy; Green, Janette; Graaff, Stephen de

doi:10.1191/0269215500cr357oa

Cited by 12 publications

(10 citation statements)

References 2 publications

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“…Details of the complete dataset and the recommended classification — the Australian National Sub‐Acute and Non‐Acute Patient (AN‐SNAP) classification 4 — are reported elsewhere 5 . ‐ 7 …”

Section: Methodsmentioning

confidence: 99%

Urinary incontinence in subacute care — a retrospective analysis of clinical outcomes and costs

Green

Smoker

et al. 2003

Medical Journal of Australia

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Objective: To investigate the effect of incontinence on clinical outcomes and costs for patients in subacute care. Design: Retrospective analysis of data collected over a 3‐month period in 1996. Setting: 54 medical facilities in Australia and New Zealand providing subacute care in an inpatient setting. Patients: 6773 episodes of care provided to 6455 rehabilitation and geriatric evaluation and management patients. Main outcome measures: Urinary continence status, treatment outcomes, length of stay, discharge destination, and nursing and allied healthcare costs. Results: Discharge destination differed between incontinent and continent patients (57% compared with 82%, respectively, discharged home, and 29% compared with 12%, respectively, discharged to a nursing home or to further care). There was a difference in cost between patients who were continent and those who were incontinent throughout their episode of care (rehabilitation: $185.60 [95% CI, $181–$190] per day for incontinent and $156.82 [95% CI, $153–$160] for continent patients; and geriatric evaluation and management: $164.62 [95% CI, $157–$172] for incontinent and $121.40 [95% CI, $114–$129] for continent patients). However, multilevel analyses showed that, after allowing for age and level of functional independence, the contribution of continence status to the cost of care depended on the functional independence of the patient (cognitive function for orthopaedic patients [P < 0.01] and motor function for stroke patients [P = 0.04]). Conclusion: The relationship between continence status and cost of care is complex. However, the cost differences found in our study need to be considered in payment systems, allocation of staff levels on wards and in development of casemix classifications.

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Section: Methodsmentioning

confidence: 99%

Urinary incontinence in subacute care — a retrospective analysis of clinical outcomes and costs

Green

Smoker

et al. 2003

Medical Journal of Australia

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“…5 Accurate outcome prediction based on patient classification on admission to rehabilitation is also an important management tool because it can indicate the need for funding.…”

Section: Discussionmentioning

confidence: 99%

“…Patients are selectively accepted for rehabilitation based on their suitability. 5,16 Between 19% and 46% of patients with acute stroke are referred for rehabilitation, [17][18][19] with this varying by unit. We studied 3 geriatric and rehabilitation units, as opposed to specialized stoke units.…”

Section: Discussionmentioning

confidence: 99%

“…4 Only 2 studies have investigated the utility of AN-SNAP to predict short-term outcomes of rehabilitation for patients with stroke. Lowthian 5 showed that AN-SNAP accurately predicted 31% of the variation in LOS in 547 patients and recommended the further development of AN-SNAP as a casemix tool. However, their study used retrospectively collected data and was restricted to patients in a private rehabilitation setting who received a 7-day/week rehabilitation program of 5 to 6 hours per day.…”

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confidence: 99%

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Length of Stay, Discharge Destination, and Functional Improvement

Tooth

McKenna²,

Goh³

et al. 2005

Stroke

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Background and Purpose-Although implemented in 1998, no research has examined how well the Australian National Subacute and Nonacute Patient (AN-SNAP) Casemix Classification predicts length of stay (LOS), discharge destination, and functional improvement in public hospital stroke rehabilitation units in Australia. Methods-406 consecutive admissions to 3 stroke rehabilitation units in Queensland, Australia were studied. Sociodemographic, clinical, and functional data were collected. General linear modeling and logistic regression were used to assess the ability of AN-SNAP to predict outcomes. Results-AN-SNAP significantly predicted each outcome. There were clear relationships between the outcomes of longer LOS, poorer functional improvement and discharge into care, and the AN-SNAP classes that reflected poorer functional ability and older age. Other predictors included living situation, acute LOS, comorbidity, and stroke type. Conclusions-AN-SNAP is a consistent predictor of LOS, functional change and discharge destination, and has utility in assisting clinicians to set rehabilitation goals and plan discharge.

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“…4 The Australian National Subacute and Nonacute Patient Casemix Classification used a similar approach to categorize stroke and SCI patients. [5][6][7][8] Casemix groupings employed in the United States for medicare reimbursement also take into account functional status and age. 9 RPG methodology uses 12 items to calculate the admission motor FIM score (excludes tub/shower transfers).…”

Section: Benchmarking and Los Targetsmentioning

confidence: 99%

Impact of benchmarking and clinical decision making tools on rehabilitation length of stay following spinal cord injury

et al. 2012

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Study design: Performance improvement initiative. Objectives: To improve efficiency of spinal cord rehabilitation by reducing length of stay (LOS) while maintaining or improving patient outcomes. Setting: Academic hospital in Canada. Methods: LOS benchmarking was completed using national comparator data from the Canadian Institute for Health Information (CIHI). Clinical decision-making tools were developed to support implementation and sustainability. A standardized 'tentative discharge date' calculator was created to establish objective LOS targets. Defined discharge criteria and an accompanying clinical decision tree were developed to support team decision making and improve transparency. A revised patient census tool was also implemented to improve team communication and facilitate data collection. The initiative was implemented in March 2010 and the following metrics were evaluated: LOS, Functional Independence Measure (FIM) change and FIM efficiency.

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The Australian National Sub-acute and Non-acute Patient Casemix Classification (AN-SNAP): its application and value in a stroke rehabilitation programme

Cited by 12 publications

References 2 publications

Urinary incontinence in subacute care — a retrospective analysis of clinical outcomes and costs

Urinary incontinence in subacute care — a retrospective analysis of clinical outcomes and costs

Length of Stay, Discharge Destination, and Functional Improvement

Impact of benchmarking and clinical decision making tools on rehabilitation length of stay following spinal cord injury

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