The cost-effectiveness of rehabilitation in the home: a study of Swedish elderly.

Abstract

OBJECTIVES. To investigate whether care of elderly and disabled patients could be more cost-effective after a short-term hospital stay, we examined the impact of a primary home care intervention program on functional status, use and costs of care after 6 months. METHODS. When clinically ready for discharge from the hospital, chronically ill patients with dependence in one to five functions in personal activities of daily living were randomized to physician-led primary home care with a 24-hour service, and the controls were offered ordinary care. Physical, cognitive, social, and medical functions were assessed in 110 team subjects and 73 controls. Data regarding inpatient days and outpatient visits were collected and converted to costs. RESULTS. Team patients demonstrated better instrumental activities of daily living and outdoor walking and significantly fewer diagnoses and drugs at 6 months. They used less inpatient and more outpatient care compared with the control patients. Significant cost reductions were found in the team group. CONCLUSIONS. This primary home care intervention program is cost-effective, at least for a selection of patients at risk for long-term hospital care.

Systematic review. The effects of supporting discharge from hospital to home in older people

“…We used supplementary unpublished data for two of the studies [27,[29][30][31][32] in the analysis. Details of the characteristics and quality of the included studies are presented in Table 1.…”

“…The support in the trials was provided for variable durations. In the majority, support had been withdrawn by 16 weeks post-discharge, but in two trials [29][30][31][32][33] the exact duration of support was not stated, and in one the support was tapered over a period of 9 months [36]. All were open to some degree to selection bias, either by virtue of their small size or because allocation concealment was inadequate or unclear.…”

“…Unfortunately, there was important variation in how 'institutionalization' was quantified-two studies [24,25,28] measured the numbers in long-stay care at a specific point in time; four studies [26,27,[29][30][31][32][33] the number admitted at any stage over a period of time, including total duration; and one study [23] both. This precluded the use of meta-analysis.…”

A systematic review of discharge arrangements for older people

“…Nineteen trials reported on some aspect of physical functioning 58,69,[71][72][73][74][75][76][77][78][79][80]82,84,86,88,90,93,95,96,99,102 ( Table 59 ). Eleven of these studies used physical function scales (e.g.…”

Comparing the cost-effectiveness and clinical effectiveness of a new community in-reach rehabilitation service with the cost-effectiveness and clinical effectiveness of an established hospital-based rehabilitation service for older people: a pragmatic randomised controlled trial with microcost and qualitative analysis – the Community In-reach Rehabilitation And Care Transition (CIRACT) study

“…23 To address this problem we undertook a structured literature review and identified systematic and Cochrane reviews of early supported discharge, discharge planning from hospital to home and care transition interventions. [3][4]9,18,[23][24][25][26][27] The key components of successful service models included (1) more intensive rehabilitation; (2) working more closely with the patient and his or her relatives; and (3) bridging interventions with a dedicated transition provider, either a nurse or a case manager, as the clinical leader, with an over-riding emphasis on having an advocate to facilitate co-ordination of care and outreach to patients following discharge from hospital.…”