Abstract
Process and Outcome Study on Rehabilitation Service for Hemiplegic Patient Causing by Stroke at the Sirindhorn National Medical Rehabilitation Center Stroke or Cerebrovascular disease (CVD) is the main leading cause of health problem among Thai population. The advance medical technology help the stroke victims to survive longer with another kind of problem, physical impairment and disability. Rehabilitation is another health care intervention which play a major role in restoring physical function and supporting them to return to their own home. The study objective is to analyse the process and outcomes of the in-patient stroke rehabilitation of the Sirindhorn national Medical Rehabilitation center. It was found that stroke with hemiplegia took about 25 percent of the total nuber of admission. One hundred and thirty-seven stroke victims were admitted 166 times within five years (fiscal year 1995-1999) while 111 admissions (cases) was recruited. Among 111 cases, the ratio of male:female was 3:2 whereas the mean age was 60.67+11.96 years (95%CI.= 58.42-62.92 yrs.). Those were left hemiplegia 2-3 times more than right hemiplegia. Seventy-five percent of those could be determined the type of CVD which showed that infarction is 2 times over than haemorrhage. The average length of stay (LOS) was 44.22+28.36 days (95%CI. = 38.88-49.55 days) while 7 and 150 days were used as the trimming points. When the trimming points were substituted with 13 and 84 days, the average LOS became 42.31+19.11 days (95%CI. = 38.18-46.43 days) According to the outcomes study, 13/48 cases of the year 1999 were recruited. It was shown that 10/13 cases were partial independent in performing the activities of daily living while 7/13 cases could walk independently. Moreover, the qualitative data of 4 selected cases pointed that they are still seeking for the treatment and rehabilitation which might cure the disability. Most of the costs for such a health care process were the family's out of pocket money. The results of the study revealed the deficiency of the health care system such as; lacking of the standard of stroke rehabilitation service, non-systematic and unreliable medical record, lacking of the outcome measures for monitoring and evaluation etc.. It was suggested that the quality improving process should be implemented especially at the Sirindhorn National Medical Rehabilitation center, the only national medical rehabilitation institute in Thailand.
