Cost-efficiency of longer-stay rehabilitation programmes: Can they provide value for money?

Turner-Stokes, Lynne

doi:10.1080/02699050701591445

Cited by 47 publications

(47 citation statements)

References 16 publications

(19 reference statements)

Supporting

Mentioning

Contrasting

Order By: Relevance

“…The fixed costs represent generic overheads whilst variable costs are patient-specific and relate to the particular treatment that is received. This is supported by Turner-Stokes, 2007 'the cost of providing rehabilitation is largely determined by time and effort', that is, by LOS and treatment intensity.…”

Section: Costingmentioning

confidence: 73%

“…The validity of this assertion is strengthened by many subsequent studies, including Turner- A year later, the study is extended (Turner-Stokes, 2007) to examine the cost-efficacy of providing ABI patients with longer rehabilitation programmes. This study aims to 'determine whether highly dependent patients who remain in rehabilitation beyond the average of 3-4 months continue to make meaningful change'.…”

Section: Chapter Twomentioning

confidence: 99%

“…They are used in Marshall et al, 2001 to predict discharge destination and LOS for geriatric patients based on a number of causal variables (age, gender, admission method etc) The statement of this really does underline the congruity between geriatric and ABI care; not only in terms of the relationship between the hospital and the community but with regard to the advantages of providing greater functional ability on discharge (Turner-Stokes, 2007).…”

Section: Queuing Theory Models (Geriatric)mentioning

confidence: 99%

See 2 more Smart Citations

Modelling activities at a neurological rehabilitation unit

Griffiths

Williams

Wood

2013

European Journal of Operational Research

View full text Add to dashboard Cite

DeclarationThis work has not previously been accepted in substance for any degree and is not concurrently being submitted in candidature for any degree. Signed:Date: Statement 1This thesis is the result of my own investigations, except where otherwise stated. Other sources are acknowledged by giving explicit references. A bibliography is appended. Signed:Date: Statement 2I hereby give consent for my thesis, if accepted, to be available for photocopying and interlibrary loan, and for the title and summary to be made available to outside organisations. SummaryA queuing model is developed for the neurological rehabilitation unit at Rookwood Hospital in Cardiff. Arrivals at the queuing system are represented by patient referrals and service is represented by patient length of stay (typically five months). Since there are often delays to discharge, length of stay is partitioned into two parts: admission until date ready for discharge (modelled by Coxian phase-type distribution) and date ready for discharge until ultimate discharge (modelled by exponential distribution). The attributes of patients (such as age, gender, diagnosis etc) are taken into account since they affect these distributions. A computer program has been developed to solve this multi-server (21 bed) queuing system to produce steady-state probabilities and various performance measures.However, early on in the project it became apparent that the intensity of treatment received by patients has an effect on the time, from admission, until they are ready for discharge. That is, the service rates of the Coxian distribution are dependent on the amount of therapy received over time. This directly relates to the amount of treatment allocated in the weekly timetables. For the physiotherapy department, these take about eight hours to produce each week by hand. In order to ask the valuable what-if questions that relate to treatment intensity, it is therefore necessary to produce an automated scheduling program that replicates the manual assignment of therapy. The quality of timetables produced using this program was, in fact, considerably better than its alternative and so replaced the by-hand approach. Other benefits are more clinical time (since less employee input is required) and a convenient output of data and performance measures that are required for audit purposes.Once the model is constructed a number of relevant hypothetical scenarios are considered.Such as, what if delays to discharge are reduced by 50%? Also, through the scheduling program, the effect of changes to the composition of staff or therapy sessions can be evaluated, for example, what if the number of therapists is increased by one third? The effects of such measures are analysed by studying performance measures (such as throughput and occupancy) and the associated costs.

show abstract

Section: Costingmentioning

confidence: 73%

Section: Chapter Twomentioning

confidence: 99%

Section: Queuing Theory Models (Geriatric)mentioning

confidence: 99%

See 1 more Smart Citation

Modelling activities at a neurological rehabilitation unit

Griffiths

Williams

Wood

2013

European Journal of Operational Research

View full text Add to dashboard Cite

show abstract

“…[25,26] There may be confusion between predicting natural unassisted recovery and predicting responsiveness to targeted rehabilitation. All those involved in stroke care are fully aware of the numbers of individuals who make substantial improvements many months, if not years, after stroke -yet there is no systematic study of this phenomenon.…”

Section: Introductionmentioning

confidence: 99%

Accessing rehabilitation after stroke – a guessing game?

Enderby

Pandyan

Bowen

et al. 2016

Disability and Rehabilitation

View full text Add to dashboard Cite

Aim: To explore the use, meaning and value of the term ''rehabilitation potential''. Method: The authors of this commentary met to discuss concerns relating to the pressure on health service staff created by reduced length of stay in acute settings of those who have suffered a stroke and the need to determine the potential of a patient for rehabilitation in order to inform discharge arrangements. Points raised at this meeting were shared with an email group who over a 12-month period contributed to this paper. Results: The group agreed that: (a) Given that there is very limited evidence to guide judgements regarding rehabilitation potential following stroke at an early stage the need for rehabilitation needs to be reviewed on a regular basis over a long period and that this needs to be reflected in clinical guidelines. (b) Rehabilitation needs to be available in a broad range of care settings, in order that discharge from hospital is not equated with a lack of rehabilitation potential. (c) Research related to rehabilitation potential needs to be conducted. This should examine influences of decision-making and the algorithms associated with recovery and local policy on rehabilitation potential. (d) The economic benefits of rehabilitation needs further exploration. (e) Assessment of rehabilitation potential should be made more explicit and supported by appropriate evidence. Conclusion: Whilst further research is required to assist in determining the right time for people to benefit from formal rehabilitation this gives the impression that one dose of rehabilitation at a specific time will meet all needs. It is likely that a rehabilitation pathway identifying features required in the early stages following stroke as well as that required over many years in order to prevent readmission, maintain fitness and prevent secondary sequelae such as depression and social isolation would be beneficial. ä IMPLICATIONS FOR REHABILITATION

show abstract

“…Turner-Stokes (2007) examines the efficiency of longer-stay rehabilitation programs completed by adults with complex neurological disabilities in the UK. Her results suggest that the long-term savings in the cost of ongoing care offsets the increased costs of rehabilitation due to longer lengths of stay and, thus, the longer in-patient rehabilitation is cost-efficient (TurnerStokes 2007).…”

Section: Introductionmentioning

confidence: 99%

Before-After Differences in Labor Market Outcomes for Participants in Medical Rehabilitation in Germany

Petrunyk

Pfeifer²,

Fischer

et al. 2015

Schmollers Jahrbuch

View full text Add to dashboard Cite

Standard-Nutzungsbedingungen:Die Dokumente auf EconStor dürfen zu eigenen wissenschaftlichen Zwecken und zum Privatgebrauch gespeichert und kopiert werden.Sie dürfen die Dokumente nicht für öffentliche oder kommerzielle Zwecke vervielfältigen, öffentlich ausstellen, öffentlich zugänglich machen, vertreiben oder anderweitig nutzen.Sofern die Verfasser die Dokumente unter Open-Content-Lizenzen (insbesondere CC-Lizenzen) zur Verfügung gestellt haben sollten, gelten abweichend von diesen Nutzungsbedingungen die in der dort genannten Lizenz gewährten Nutzungsrechte. Terms of use: Documents in AbstractThe authors address the issue of effectiveness of medical rehabilitation in terms of labor market outcomes by analyzing a large representative administrative panel data set for Germany. The research design focuses on socio-demographic group differences in before-after differences in days with unemployment benefits, days in employment, and labor income of participants in medical rehabilitation. The mean before-after differences indicate that medical rehabilitation is rather ineffective with respect to labor market outcomes, because the number of days with unemployment benefits is larger and the number of working days and labor income are smaller after the rehabilitation than before. The differences in the before-after differences are however large between socio-demographic groups. For example, older participants perform significantly worse and better educated participants have significant better labor market outcomes after the rehabilitation than before, whereas gender differences are small.

show abstract

Cost-efficiency of longer-stay rehabilitation programmes: Can they provide value for money?

Abstract: The additional investment in longer-stay rehabilitation in this group of complex patients was offset relatively quickly by long-term savings in the cost of care.

Cited by 47 publications

References 16 publications

Modelling activities at a neurological rehabilitation unit

Modelling activities at a neurological rehabilitation unit

Accessing rehabilitation after stroke – a guessing game?

Before-After Differences in Labor Market Outcomes for Participants in Medical Rehabilitation in Germany

Contact Info

Product

Resources

About