An economic evaluation of an integrated care pathway in geriatric rehabilitation for older patients with complex health problems

Abstract

BackgroundIntegrated care pathways which cover multiple care settings are increasingly used as a tool to structure care, enhance coordination and improve transitions between care settings. However, little is known about their economic impact. The objective of this study is to determine the cost-effectiveness and cost-utility of an integrated care pathway designed for patients with complex health problems transferring from the hospital, a geriatric rehabilitation facility and primary care.MethodsThis economic evaluation was performed from a societal perspective alongside a prospective cohort study with two cohorts of patients. The care as usual cohort was included before implementation of the pathway and the care pathway cohort after implementation of the pathway. Both cohorts were measured over nine months, during which intervention costs, healthcare costs, patient and family costs were identified. The outcome measures were dependence in activities of daily living (measured with the KATZ-15) and quality adjusted life years (EQ-5D-3L). Costs and effects were bootstrapped and various sensitivity analyses were performed to assess robustness of the results.ResultsAfter nine months, the average societal costs were significantly lower for patients in the care pathway cohort (€50,791) versus patients in the care as usual cohort (€62,170; CI = -22,090, -988). Patients in the care pathway cohort had better scores on the KATZ-15 (1.04), indicating cost-effectiveness. No significant differences were found between the two groups on QALY scores (0.01).ConclusionsThe results of this study indicate that the integrated care pathway is a cost-effective intervention. Therefore, dissemination of the integrated care pathway on a wider scale could be considered. This would provide us the opportunity to confirm the findings of our study in larger economic evaluations. When looking at QALYs, no effects were found. Therefore, it is also recommended to explore if therapy in geriatric rehabilitation could also pay attention to other quality of life-related domains, such as mood and social participation.

Healthcare Costs for Older Patients Before and After Inpatient Rehabilitation: A Retrospective and Prospective Longitudinal Cohort Study

“…This may explain why the mean costs for therapies were higher in the 12-month period after discharge from geriatric rehabilitation compared with the 12 months before rehabilitation. Everink et al showed previously that patients undergoing an integrated care pathway in geriatric rehabilitation incurred significantly lower healthcare costs in a 9-month follow-up period, mainly due to shorter hospital stays and shorter stays in the geriatric rehabilitation facility [13]. Our findings are in accordance with this trial.…”

“…Furthermore, rehabilitation does not lead to increased total costs for healthcare [8,12]. A recent study showed that an integrated care pathway in geriatric rehabilitation, compared with usual care, is cost-effective and improves independence in activities of daily living (ADL) [13]. In contrast, a randomized controlled trial by Kehusmaa et al showed that a geriatric inpatient rehabilitation programme was not cost-effective compared with standard care [14].…”

Integrated Model of Care for Polycystic Ovary Syndrome

“…20,21 Despite a lack of well-validated tools and measurements to fully evaluate integrated care interventions, there is growing evidence that disease-specific integrated model of care programs for chronic conditions associated with multiple comorbidities (e.g., diabetes, inflammatory bowel disease, chronic obstructive pulmonary disease) are beneficial in reducing health-related cost, improving quality of life and health outcomes. [22][23][24][25][26][27] Transformation into an integrated model of care is complex and there is no single framework that fits all settings or target groups. Engagement of patients, their families (if culturally appropriate), and communities is critical and just as important as collaboration from the health policy makers and healthcare providers in identifying the area of need and the designing of the model of care to ensure the healthcare service meets the evolving demands of its consumers.…”

Clinical effectiveness of an intermediate care inpatient model based on integrated care pathways

“…Since 2006, the activity of various centers in this area has shifted to integrated approaches of care, intended to enhance coordination between healthcare professionals to improve care transitions and create a continuum through the various levels of care . Although the impact of integrated care pathways on healthcare costs is still a matter of debate, their implementation has proven significant benefits regarding patient's quality of life, dependence level, satisfaction and perceived quality of care …”

“…[4][5][6] Although the impact of integrated care pathways on healthcare costs is still a matter of debate, their implementation has proven significant benefits regarding patient's quality of life, dependence level, satisfaction and perceived quality of care. [7][8][9] Integrated care models require the interaction between various healthcare providers and, therefore, their implementation should be tailored to the healthcare organization of each area. In this regard, some authors have stressed the need to consider contextual differences before implementing the same model in different locations.…”