Abstract
In Japan, the national medical insurance system and long-term care insurance (LTCI) system cover rehabilitation therapy for patients with acute, convalescent, and chronic stroke. Medical insurance covers early and multidisciplinary rehabilitation therapy during acute phase hospitalizations. Patients requiring assistance in their activities of daily living (ADL) after hospitalization are transferred to kaifukuki (convalescent) rehabilitation wards (KRW), which the medical insurance system has also covered. In these wards, patients can receive intensive and multidisciplinary rehabilitation therapy to improve their ADL and transition to a smooth home discharge. After discharge from these hospitals, elderly patients with stroke can receive outpatient (day-care) rehabilitation and home-based rehabilitation using the LTCI system. The Japanese government has proposed building a community-based integrated care system by 2025 to provide comprehensive medical services, long-term care, preventive care, housing, and livelihood support for patients. This policy aims to promote smooth coordination between medical insurance services and LTCI providers. Accordingly, the medical insurance system allows hospitals to receive additional fees by providing patient information to rehabilitation service providers in the LTCI system. A comprehensive database on acute, convalescent, and chronic phase stroke patients and seamless cooperation between the medical care system and LTCI system is expected to be established in the future. There are only 2,613 board-certified physiatrists in Japan, and many medical schools lack a department for rehabilitation medicine; establishing such a department at each school is encouraged to teach students efficient medical care procedures, to conduct research, and to facilitate the training of personnel in comprehensive stroke rehabilitation.
Highlights
Stroke has been the number one cause of death among Japanese people, but has shifted to the fourth most common cause in recent years due to decreasing mortality rates, with cancer as the first, heart disease second, and senility third
The results showed that a good prognosis at discharge was more likely in the group of patients who started rehabilitation treatment on the day of or after admission
Mobilization, basic movement training, gait training, and activities of daily living (ADL) training are implemented as early rehabilitation
Summary
Stroke has been the number one cause of death among Japanese people, but has shifted to the fourth most common cause in recent years due to decreasing mortality rates, with cancer as the first, heart disease second, and senility third. Using the Japan Rehabilitation Database, a cohort study of 8,033 patients with the acute cerebrovascular disease showed that high-frequency rehabilitation care (7 days a week for patients with early-onset acute stroke) was associated with better functional recovery [9]. The average length of stay in the hospital was 29.5 days [10] Based on these results, the medical insurance system can facilitate early rehabilitation therapy for patients with acute stroke in hospitals. Aoki et al [12] reported that the activities of a multidisciplinary swallowing team, consisting of nurses, speech therapists, occupational therapists, audiologists, dieticians, dental hygienists, and pharmacists, reduced the incidence of pneumonia in patients with acute cerebrovascular disease Such a multidisciplinary team, facilitated by the medical insurance system, should be able to assess and manage swallowing function during the acute stroke phase
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