Urinary incontinence in subacute care — a retrospective analysis of clinical outcomes and costs

Abstract

Objective: To investigate the effect of incontinence on clinical outcomes and costs for patients in subacute care. Design: Retrospective analysis of data collected over a 3‐month period in 1996. Setting: 54 medical facilities in Australia and New Zealand providing subacute care in an inpatient setting. Patients: 6773 episodes of care provided to 6455 rehabilitation and geriatric evaluation and management patients. Main outcome measures: Urinary continence status, treatment outcomes, length of stay, discharge destination, and nursing and allied healthcare costs. Results: Discharge destination differed between incontinent and continent patients (57% compared with 82%, respectively, discharged home, and 29% compared with 12%, respectively, discharged to a nursing home or to further care). There was a difference in cost between patients who were continent and those who were incontinent throughout their episode of care (rehabilitation: $185.60 [95% CI, $181–$190] per day for incontinent and $156.82 [95% CI, $153–$160] for continent patients; and geriatric evaluation and management: $164.62 [95% CI, $157–$172] for incontinent and $121.40 [95% CI, $114–$129] for continent patients). However, multilevel analyses showed that, after allowing for age and level of functional independence, the contribution of continence status to the cost of care depended on the functional independence of the patient (cognitive function for orthopaedic patients [P < 0.01] and motor function for stroke patients [P = 0.04]). Conclusion: The relationship between continence status and cost of care is complex. However, the cost differences found in our study need to be considered in payment systems, allocation of staff levels on wards and in development of casemix classifications.

Health-related quality of life and economic impact of urinary incontinence due to detrusor overactivity associated with a neurologic condition: a systematic review

“…Our search identified one article that assessed the economic burden of patients with urodynamically confirmed NDO, and 10 articles that presented per-patient costs of UI in the general population, 2 of which reported results of subgroups of patients with neurologic disease [33,34] (Table 1). These studies were diverse in terms of perspective (payer, provider, patient, society), the type of data used (electronic medical records, surveys, interviews, model), cost components assessed (labor costs, nursing home costs, office visits, surgery, medications, diagnosis, pad usage), country of data origin (US, Australia, Italy, Spain, Germany, Sweden, UK, Thailand, Ireland), and study design (retrospective, cross-sectional, prospective).…”

“…A study evaluating the cost of UI in 54 subacute medical facilities in Australia and New Zealand found that stroke patients with high FIM motor scores were more expensive to treat if they were incontinent [34]. Another study conducted among a consecutive series of patients admitted to one of two sub-acute care facilities in Australia who had UI found that the total median daily cost of caring for UI among patients with UI of neurological origin was $19.76 [33].…”

A randomised controlled trial: outcomes of bladder rehabilitation in persons with multiple sclerosis

“…More recently 73 pwMS residing in the community1 reported significant disability due to urinary problems, with impact on quality of life (QoL), emotional health, ability to perform household chores and physical recreation. The direct and indirect costs associated with incontinence care have significant financial implications for health services 10. The severity of MS (duration, involvement of motor system) correlates with the severity of irritative bladder symptoms 2 6…”

Impact of urinary incontinence on medical rehabilitation inpatients

“…There are no United States studies reporting the prevalence of UI among rehabilitation patients across rehabilitation diagnoses. The largest non‐US study examined the prevalence of UI among rehabilitation patients in Australia and New Zealand, reporting UI in 48% of orthopedic patients, 65% of stroke patients, 61% of brain dysfunction patients, and 81% among spinal cord dysfunction patients . A recent study from Austria found UI in 60% of patients with fracture .…”