Cost-efficiency of specialist inpatient rehabilitation for working-aged adults with complex neurological disabilities: a multicentre cohort analysis of a national clinical data set

Abstract

ObjectivesTo evaluate functional outcomes, care needs and cost-efficiency of specialist rehabilitation for a multicentre cohort of inpatients with complex neurological disability, comparing different diagnostic groups across 3 levels of dependency.DesignA multicentre cohort analysis of prospectively collected clinical data from the UK Rehabilitation Outcomes Collaborative (UKROC) national clinical database, 2010–2015.SettingAll 62 specialist (levels 1 and 2) rehabilitation services in England.ParticipantsWorking-aged adults (16–65 years) with complex neurological disability. Inclusion criteria: all episodes with length of stay (LOS) 8–400 days and complete outcome measures recorded on admission and discharge. Total N=5739: acquired brain injury n=4182 (73%); spinal cord injury n=506 (9%); peripheral neurological conditions n=282 (5%); progressive conditions n=769 (13%).InterventionSpecialist inpatient multidisciplinary rehabilitation.Outcome measuresDependency and care costs: Northwick Park Dependency Scale/Care Needs Assessment (NPDS/NPCNA). Functional independence: UK Functional Assessment Measure (UK Functional Independence Measure (FIM)+FAM). Cost-efficiency: (1) time taken to offset rehabilitation costs by savings in NPCNA-estimated costs of ongoing care, (2) FIM efficiency (FIM gain/LOS days), (3) FIM+FAM efficiency (FIM+FAM gain/LOS days). Patients were analysed in 3 groups of dependency.ResultsMean LOS 90.1 (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 care costs’ was greatest in the high-dependency group at £760/week (95% CI 726 to 794)), compared with the medium-dependency (£408/week (95% CI 370 to 445)), and low-dependency (£130/week (95% CI 82 to 178)), groups. Despite longer LOS, time taken to offset the cost of rehabilitation was 14.2 (95% CI 9.9 to 18.8) months in the high-dependency group, compared with 22.3 (95% CI 16.9 to 29.2) months (medium dependency), and 27.7 (95% CI 15.9 to 39.7) months (low dependency). FIM efficiency appeared greatest in medium-dependency patients (0.54), compared with the low-dependency (0.37) and high-dependency (0.38) groups. Broadly similar patterns were seen across all 4 diagnostic groups.ConclusionsSpecialist rehabilitation can be highly cost-efficient for all neurological conditions, producing substantial savings in ongoing care costs, especially in high-dependency patients.

Requirements for and current provision of rehabilitation services for children after severe acquired brain injury in the UK: a population-based study

“…High-quality rehabilitation services are necessary to follow-through on investments in acute care 12. The cost-effectiveness of rehabilitation after severe ABI has been demonstrated in adults11 but not yet in children. Given that, except after the most severe injuries, life expectancy after paediatric ABI is near-normal,39 one might anticipate the economic case for paediatric rehabilitation to be even stronger given the remaining life-years over which to recoup gains: even more so as the full effects of paediatric ABI can take time to fully manifest, resulting in under attribution of late morbidity to paediatric ABI 7…”

Impact of specialist rehabilitation services on hospital length of stay and associated costs

“…However, existing studies either lack a control group [4, 5, 7–10] or use inappropriate comparators (e.g. compare levels of rehabilitation intensity or different rehabilitation programmes) [11–14].…”

Rasch analysis of the UK Functional Assessment Measure in a sample of patients with traumatic brain injury from the UK national clinical database

“…Reporting of UK FIM+FAM data has been a commissioning requirement for Level 1 and 2 rehabilitation services since April 2013. Specialist Level 1 and 2 rehabilitation services have a mean length of stay of approximately 90 days (SD 66) (20). The UK FIM+FAM is usually completed for each patient within 10 days of admission and during the last week before discharge, to evaluate the functional gains made during the episode of care.…”

“…However, as with many scales used for outcome evaluation in rehabilitation, the level descriptors were designed to capture the types of change that may be expected to occur within an inpatient rehabilitation setting, as the patient progresses to the level of independence required for transition to the community. In this context the range is quite suitable for the population of inpatients with complex disabilities requiring specialist rehabilitation following acquired brain injury (which is the setting in which it is used in the UK (20)). But, because the FIM+FAM is rated only on admission and discharge in UK clinical settings, there is limited opportunity to capture progression through the range of scores that may be expected to occur during the rehabilitation journey.…”