Adequacy of care management of patients with polyhandicap: The features of the French healthcare system

Abstract

The aims of this study were: –to describe the health profiles and care management of polyhandicapped patients according to 3 modalities specialized rehabilitation centers (SRC), residential facilities (RF), and home care (HC); –to estimate the adequacy of care management of these patients. This was an 18-month cross-sectional study including patients with a combination of severe motor deficiency and profound intellectual impairment. The patients were from 4 SRC, 9 RF, and a pediatric/neurologic department (HC). The following data were collected: sociodemographics, health status, care management, and adequacy of care management. A total of 875 patients were included: 410 (47%) were cared for in SRC, 372 (43%) in RF, and 84 (10%) in HC. Global objective adequacy (health severity and age category) was higher for patients cared for in SRC compared with patients cared for in RF (57 vs. 44%, P ≤10 −3 ). Global subjective adequacy (self-perception of the referring physician and request of change in structure) was higher for patients cared for in SRC (98%) in comparison with patients cared for in RF and HC (92 and 87%). This study provides key elements of adequacy of care management modalities for polyhandicapped patients in France.