An Assessment on the Ministry of Public Health’s Intermediate Care Policy: A Quantitative Analysis

Abstract

The present study aimed to 1) illustrate the situations of intermediate care according to the Minis­try of Public Health’s policy. Seventeen healthcare facilities providing acceptable intermediate care to patients with stroke, traumatic brain injury (TBI), and spinal cord injury (SCI) were multi-stage sampled from the Ministry of Public Health provider sampling frame of 897 hospitals. Questionnaire with item-ob­jective congruence index (IOC) of 0.6–1.00 was the tool used for data collection during September 2019 to March 2020. Electronic data related to inpatient intermediate care were alternative study data source. The data were analyzed with descriptive (frequency, percentage, mean, standard deviation) and inferen­tial statistics (median test, paired t-test, t-test, Pearson correlation). The findings showed that the select­ed hospitals were divided based on service data into 3 groups: 1) intensive intermediate care services, 2) moderate intermediate care services, and 3) moderate intermediate care services with limited evidence from questionnaire and individual inpatient data. The majority of patients were stroke. Group 1 commu­nity hospitals had longer length of stay (LOS) than other groups in all 3 conditions; stroke 9.2 days, TBI 13.6 days and SCI 26.8 days. The average medical expense per visit for out-patients with SCI in the pro­vincial hospitals from group 1 was the highest; 30,458 baht. The average medical expense per visit for in-patients with SCI in the hospitals from group 1 was the highest; 57,254 baht. The patients with SCI from community hospitals in group 1 had the highest re-admission rate of 38.1 per cent. The Barthel index (BI) at discharge was higher than on admission date for stroke (paired t-test_(3,423) = 30.82, p < 0.01), TBI (paired t-test₍₈₈₎ = 3.64, p < 0.01), and SCI (paired t-test₍₁₀₄₎ = 3.05, p < 0.01). The stroke patients in group 1 hospitals showed better patient functional improvement by higher improvement in Barthel index (IBI) than in group 2 hospitals (4.0 vs 1.8, independent t-test _3,381 = 12.51, p < 0.01). The medical expense had positive correlation with LOS of 3 conditions (CSI r = 0.98, p < 0.01; TBI r = 0.53, p < 0.01 and stroke r = 0.17, p < 0.01). The IBI of stroke had negative correlation with LOS (r = -0.044, p < 0.05) and with age (r = -0.035, p < 0.05). In conclusion, the intermediate care with intensive rehabilitation to enhance clinical effectiveness should be continuously supported.