Cost-efficiency of specialist hyperacute in-patient rehabilitation services for medically unstable patients with complex rehabilitation needs: a prospective cohort analysis.
Cost-efficiency of specialist hyperacute in-patient rehabilitation services for medically unstable patients with complex rehabilitation needs: a prospective cohort analysis.
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DOI：
10.1136/bmjopen-2016-012112
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发表时间：
2016-09-08
期刊：
影响因子：
2.9
通讯作者：
Sephton K
中科院分区：
文献类型：
--
作者：
Turner-Stokes L;Bavikatte G;Williams H;Bill A;Sephton K
评估一组患有复杂神经功能障碍和不稳定医疗/手术条件的住院患者的功能结果、护理需求和超急性 (HA) 康复的成本效益。对 2012-2015 年英国康复成果合作 (UKROC) 国家临床数据库前瞻性收集的临床数据进行的多中心队列分析。英国有两家医管局专科康复服务机构，为医管局康复提供不同的服务模式。所有入院康复复杂度M评分≥3的患者均入院（N=190；平均年龄46（SD16）岁；男性：女性63：37%）。诊断为获得性脑损伤（n=166；87%）、脊髓损伤（n=9；5%）、周围神经系统疾病（n=9；5%）和其他（n=6；3%）。专科住院多学科康复结合并发内科和外科问题的管理和稳定。康复复杂性和医疗敏锐度：康复复杂性量表 — 第 13 版。 抚养和护理费用：诺斯威克公园抚养量表/护理需求评估 (NPDS/NPCNA)。职能独立性：英国职能评估措施（UK FIM+FAM）。主要成果：(1) 减少依赖；(2) 成本效益，衡量为通过节省 NPCNA 估计的社区持续护理成本来抵消康复成本所需的时间。平均住院时间为 103 (SD66) 天。两个单位之间观察到了一些差异，这与不同的服务模式一致。然而，两个单位的入院和出院之间所有措施的依赖性和敏锐度均显着降低（Wilcoxon：p<0.001）。对于拥有完整 NPCNA 数据的 180 名 (95%) 患者，平均发作成本为 77 119 英镑（自举 95% CI 70 614 至 83 894 英镑），“每周护理费用”平均减少量为 462 英镑/周（95% CI 349 至 582）。抵消康复费用的平均时间为 27.6 个月（95% CI 13.2 至 43.8）。尽管其初始成本相对较高，但专科医管局康复服务具有很高的成本效益，可大幅节省持续护理成本，并缓解急症护理服务的压力。
To evaluate functional outcomes, care needs and cost-efficiency of hyperacute (HA) rehabilitation for a cohort of in-patients with complex neurological disability and unstable medical/surgical conditions. A multicentre cohort analysis of prospectively collected clinical data from the UK Rehabilitation Outcomes Collaborative (UKROC) national clinical database, 2012–2015. Two HA specialist rehabilitation services in England, providing different service models for HA rehabilitation. All patients admitted to each of the units with an admission rehabilitation complexity M score of ≥3 (N=190; mean age 46 (SD16) years; males:females 63:37%). Diagnoses were acquired brain injury (n=166; 87%), spinal cord injury (n=9; 5%), peripheral neurological conditions (n=9; 5%) and other (n=6; 3%). Specialist in-patient multidisciplinary rehabilitation combined with management and stabilisation of intercurrent medical and surgical problems. Rehabilitation complexity and medical acuity: Rehabilitation Complexity Scale—version 13. Dependency and care costs: Northwick Park Dependency Scale/Care Needs Assessment (NPDS/NPCNA). Functional independence: UK Functional Assessment Measure (UK FIM+FAM). Primary outcomes: (1) reduction in dependency and (2) cost-efficiency, measured as the time taken to offset rehabilitation costs by savings in NPCNA-estimated costs of on-going care in the community. The mean length of stay was 103 (SD66) days. Some differences were observed between the two units, which were in keeping with the different service models. However, both units showed a significant reduction in dependency and acuity between admission and discharge on all measures (Wilcoxon: p<0.001). For the 180 (95%) patients with complete NPCNA data, the mean episode cost was £77 119 (bootstrapped 95% CI £70 614 to £83 894) and the mean reduction in ‘weekly care costs’ was £462/week (95% CI 349 to 582). The mean time to offset the cost of rehabilitation was 27.6 months (95% CI 13.2 to 43.8). Despite its relatively high initial cost, specialist HA rehabilitation can be highly cost-efficient, producing substantial savings in on-going care costs, and relieving pressure in the acute care services.
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影响因子：
3.5
作者：
Siegert, Richard J.;Turner-Stokes, Lynne
通讯作者：
Turner-Stokes, Lynne
影响因子：
2.2
作者：
Turner-Stokes, Lynne;Scott, Harriet;Siegert, Richard
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Turner-Stokes, L;Nyein, K;Halliwell, D
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Turner-Stokes, Lynne;Sutch, Stephen;Dredge, Robert
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影响因子：
3
作者：
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