Efficiency of specialist rehabilitation in reducing dependency and costs of continuing care for adults with complex acquired brain injuries

Abstract

Objectives: To examine functional outcomes from a rehabilitation programme and to compare two methods for evaluating cost efficiency of rehabilitation in patients with severe complex disability. Subjects and setting: Two hundred and ninety seven consecutive admissions to a specialist inpatient rehabilitation unit following severe acquired brain injury. Methods: Retrospective analysis of routinely collected data, including the Functional Independence Measure (FIM), Barthel Index, and Northwick Park Dependency Score and Care Needs Assessment (NPDS/NPCNA), which provides a generic estimation of dependency, care hours. and weekly cost of continuing care in the community. Patients were analysed in three groups according to dependency on admission: ''low'' (NPDS,10 (n = 83)); ''medium'' (NPDS10-24 (n = 112)); ''high'' (NPDS .24 (n = 102)). Results: Mean length of stay (LOS) 112 (SD 66) days. All groups showed significant reduction in dependency between admission and discharge on all measures (paired t tests: p,0.001). Mean reduction in ''weekly cost of care'' was greatest in the high dependency group at £639 per week (95% CI 488 to 789)), as compared with the medium (£323/week (95% CI 217 to 428)), and low (£111/week (95% CI 42 to 179)) dependency groups. Despite their longer LOS, time taken to offset the initial cost of rehabilitation was only 16.3 months in the high dependency group, compared with 21.5 months (medium dependency) and 38.8 months (low dependency). FIM efficiency (FIM gain/LOS) appeared greatest in the medium dependency group (0.25), compared with the low (0.17) and high (0.16) dependency groups. Conclusions: The NPDS/NPCNA detected changes in dependency potentially associated with substantial savings in the cost of ongoing care, especially in high dependency patients. Floor effects in responsiveness of the FIM may lead to underestimation of efficiency of rehabilitation in higher dependency patients.

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

“…The estimated cost of care is therefore independent of individual circumstances or local policy for the provision continuing care, which varies widely across the UK. Previous evaluations have demonstrated the reliability and validity of the NPDS and NPCNA [13,14,16] and have used the tools to demonstrate that the costs of rehabilitation can be offset by savings in the cost of ongoing care within a relative short time frame [12]. The UKFIMþFAM includes the Functional Independence Measure (FIM TM ) version 4 and a derived Barthel Index (BI) according to a computerized algorithm [17], these assessments are provided in this report as a point of reference for readers who are less familiar with the NPDS/NPCNA.…”

“…Some patients with particularly complex needs are admitted to 'complex specialized' rehabilitation programmes, where lengths of stay are typically 3-4 months [9], but a few may stay in rehabilitation for 12 months or more if they are seen to be making continued gains. Previous authors have highlighted the potential for long-term functional gains in the severely affected slow-to-recover group [10,11] and recent evidence suggests that, despite their substantially longer lengths of stay, the increased cost of rehabilitation is very readily offset by long-term savings in the cost of care [12] so that in-patient rehabilitation was in fact highly costefficient in the most dependent group of patients. However, this could simply reflect the increased opportunity for change from a very dependent starting point.…”

What reductions in dependency costs result from treatment in an inpatient neurological rehabilitation unit for people with stroke?

“…8 This was not the case and confirms the work of other groups in the UK. 20 Even those whose initial care costs would have been high (over £1,000, £2,000 or £3,000) gained independence with reduced care costs.…”

Cost effectiveness of inpatient rehabilitation in patients with brain injury

“…Similar to previous analyses, 9,15 we calculated the savings in cost of care by calculating the average difference between care costs on admission and on discharge. In these previous analyses estimated care costs were based on the Northwick Park Dependency Scale, but this is not used at our centre.…”