The longitudinal development of a rehabilitation agency: an integrated rehabilitation service delivery model.

Health care services in the late 1980's are undergoing drastic changes. Similarly the laws, insurance regulations, etc. are changing so rapidly that the health care system appears to be having a difficult time keeping up with the ever changing needs of the consumers (that is, the patients). Diagnosis Related Groups (DRGs) have resulted in decreased hospital stays for patients with subacute and chronic conditions, and therefore patients are being care for in outpatient rehabilitation agencies, and/or outpatient clinics associated with hospitals. In short, a patient cannot stay in the hospital unless he or she is acutely ill or in need of surgery. Outpatient care is gradually becoming more important since patients who would have still been in the hospital several years ago, are now released to go home, with an order to receive outpatient therapy at the local rehabilitation agency. Currently there is no model available for starting an outpatient rehabilitation agency, and as a result health care professionals interested in starting such a facility have no guidelines or methodology for establishing a private rehabilitation practice.