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Johnson JK. Learning Health Systems Are Well Suited to Define and Deliver the Physical Therapy Value Proposition. Phys Ther 2023; 103:pzad072. [PMID: 37379334 DOI: 10.1093/ptj/pzad072] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2023] [Revised: 02/15/2023] [Accepted: 04/04/2023] [Indexed: 06/30/2023]
Affiliation(s)
- Joshua K Johnson
- Physical Medicine and Rehabilitation, Neurological Institute, Cleveland Clinic, Cleveland, Ohio, USA
- Rehabilitation and Sports Therapy, Neurological Institute, Cleveland Clinic, Cleveland, Ohio, USA
- Center for Value-Based Care Research, Primary Care Institute, Cleveland Clinic, Cleveland, Ohio, USA
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Turner-Stokes L, Lafeuillee G, Francis R, Nayar M, Nair A. Functional outcomes and cost-efficiency of specialist in-patient rehabilitation following spinal cord injury: a multi-centre national cohort analysis from the UK Rehabilitation Outcomes Collaborative (UKROC). Disabil Rehabil 2021; 44:5603-5611. [PMID: 34282991 DOI: 10.1080/09638288.2021.1946603] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Purpose: To evaluate functional outcomes, care needs and cost-efficiency of specialist rehabilitation for a multi-centre cohort of inpatients with spinal cord injury (SCI)-comparison based on age and aetiology.Methods and materials: Retrospective analysis of prospectively collected data from the UK Rehabilitation Outcomes Collaborative (UKROC) national clinical database from 2012-2019. Adults with SCI admitted for a rehabilitation programme in levels 1 and 2 specialist rehabilitation Units in England, were included if they had valid UK Functional Assessment Measure (UK FIM + FAM) and Northwick Park Dependency Scale (NPDS) scores recorded on admission and discharge (n = 2506 of 3321 admissions).Results: Approximately 425 patients were admitted yearly. 1344(56%) patients were under 65. 736(29%) had traumatic aetiology. Older and Traumatic SCI patients were more likely to have cervical cord damage (X2, p < 0.001). There was a significant improvement in all parameters of functional independence (UK FIM + FAM) (p < 0.001), with the reduction in dependency and care costs (NPDS/NPCNA) (p < 0.001). 1817(72.5%) patients were discharged home. Mean care-costs savings were £25 500/year per patient. Year-on-year trends showed admissions with increasing age, higher complexity and dependency with corresponding increasing episode costs (ANOVA p < 0.001). However, the time taken to offset the cost of rehabilitation did not change significantly (ANOVA p = 0.57).Conclusions: Specialist rehabilitation services provide effective and cost-efficient rehabilitation for patients with spinal cord injury.Implications for RehabilitationApproximately a third of patients who access specialist inpatient rehabilitation following spinal cord injury (SCI) in England are managed in the Specialist Level 1 and 2 neuro-rehabilitation units, rather than in the eight designated national SCI Centres.Despite admitting progressively more complex and dependent patients over eight years, these specialist rehabilitation units continue to provide highly cost-efficient care.The mean annual savings amount to £25,500 per patient. With a mean admission rate of 425 patients, this would generate total savings in excess of £10 million per year for the cohort.Specialist rehabilitation services play an important, but under-recognised, role in the spinal cord injury care pathway.
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Affiliation(s)
- Lynne Turner-Stokes
- Department of Palliative Care, Policy and Rehabilitation, Cicely Saunders Institute, Florence Nightingale Faculty of Nursing, Midwifery and Palliative Care, King's College London, London, UK.,UK Rehabilitation Outcomes Collaborative, Northwick Park Hospital, London, UK
| | - Gisele Lafeuillee
- Queen Mary's Hospital, St. George's University Hospitals NHS Foundation Trust, London, UK
| | - Richard Francis
- UK Rehabilitation Outcomes Collaborative, Northwick Park Hospital, London, UK
| | - Meenakshi Nayar
- Charing Cross Hospital, Imperial College Healthcare NHS Trust, London, UK.,Hillingdon Hospital, The Hillingdon Hospitals NHS Foundation Trust, London, UK
| | - Ajoy Nair
- Charing Cross Hospital, Imperial College Healthcare NHS Trust, London, UK.,Hillingdon Hospital, The Hillingdon Hospitals NHS Foundation Trust, London, UK
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Lee HY, Park JH, Kim TW. Cross-cultural adaptation and psychometric validation of the Korean version of rehabilitation complexity scale for the measurement of complex rehabilitation needs. Medicine (Baltimore) 2021; 100:e26259. [PMID: 34128854 PMCID: PMC8213332 DOI: 10.1097/md.0000000000026259] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/26/2020] [Accepted: 05/20/2021] [Indexed: 01/04/2023] Open
Abstract
The aim of this study was to translate and cross-culturally adapt the Rehabilitation Complexity Scale-Extended version 13 (RCS-E v13) to develop the Korean version of the Rehabilitation Complexity Scale (KRCS), and to explore its reliability, and concurrent and construct validity.This research was an observational study of a series of consecutive rehabilitation inpatients who were previously assessed with KRCS and grouped with the Korean rehabilitation patient group version 1.1 (KRPG v1.1). Translation and cross-cultural adaptation of the RCS-E v13 were implemented according to internationally recognized standards. Four hundred thirty inpatients diagnosed with complex neurological or musculoskeletal disabilities were enrolled. Physiatrists were asked to finish the KRCS at admission and to complete a second time with an interval of a minimum of 3 weeks to a maximum of 4 weeks for reliability evaluation. At discharge, the KRCS was completed a third time to explore constructive validity.The Cronbach-α was 0.63. The intraclass correlation coefficient values of the total score, Medical, Nursing, Care, Therapy Disciplines, Therapy Intensity, and Especial Needs domains were 0.86, 0.69, 0.84, 0.83, 0.74, 0.74, and 0.79, respectively (P < .01). The scale was repeatable (Spearman rho 0.69-0.86) and correlated strongly with disability measures (Spearman rho 0.37-0.50). Exploratory factor analysis revealed 2 clear factors ("Medical/Nursing" and "Care/Therapy Disciplines/Therapy Intensity/Equipment"). The goodness-of-fit index in the confirmatory factor analysis was 0.87. The KRCS was associated with a higher explanatory power for rehabilitation resources and length of stay than the KRPG v1.1.Our data suggest that the KRCS is a feasible, reliable, and valid tool that is appropriate for the measurement of clinical complexity in Korean intensive rehabilitation units. Further, it may provide case-mix adjustment to improve the rehabilitation delivery system in Korea.
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Affiliation(s)
- Hoo Young Lee
- TBI Rehabilitation Center, National Traffic Injury Rehabilitation Hospital, Gyeonggi-do
- Department of Rehabilitation Medicine, Seoul National University Hospital, Seoul University College of Medicine, Seoul
- Traffic Injury Rehabilitation Research Institute, National Traffic Injury Rehabilitation Hospital, Gyeonggi-do
- Department of Medicine, Yonsei University College of Medicine, Seoul
| | - Jung Hyun Park
- Department of Medicine, Yonsei University College of Medicine, Seoul
- Department of Rehabilitation Medicine, Gangnam Severance Hospital, Rehabilitation Institute of Neuromuscular Disease, Yonsei University College of Medicine, Seoul, South Korea
| | - Tae-Woo Kim
- TBI Rehabilitation Center, National Traffic Injury Rehabilitation Hospital, Gyeonggi-do
- Department of Rehabilitation Medicine, Seoul National University Hospital, Seoul University College of Medicine, Seoul
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Estimated Life-Time Savings in the Cost of Ongoing Care Following Specialist Rehabilitation for Severe Traumatic Brain Injury in the United Kingdom. J Head Trauma Rehabil 2020; 34:205-214. [PMID: 30801440 PMCID: PMC6687405 DOI: 10.1097/htr.0000000000000473] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Supplemental Digital Content is Available in the Text. Objectives: To evaluate cost-efficiency of rehabilitation following severe traumatic brain injury (TBI) and estimate the life-time savings in costs of care. Setting/Participants: TBI patients (n = 3578/6043) admitted to all 75 specialist rehabilitation services in England 2010–2018. Design: A multicenter cohort analysis of prospectively collated clinical data from the UK Rehabilitation Outcomes Collaborative national clinical database. Main Measures: Primary outcomes: (a) reduction in dependency (UK Functional Assessment Measure), (b) cost-efficiency, measured in time taken to offset rehabilitation costs by savings in costs of ongoing care estimated by the Northwick Park Dependency Scale/Care Needs Assessment (NPDS/NPCNA), and (c) estimated life-time savings. Results: The mean age was 49 years (74% males). Including patients who remained in persistent vegetative state on discharge, the mean episode cost of rehabilitation was £42 894 (95% CI: £41 512, £44 235), which was offset within 18.2 months by NPCNA-estimated savings in ongoing care costs. The mean period life expectancy adjusted for TBI severity was 21.6 years, giving mean net life-time savings in care costs of £679 776/patient (95% CI: £635 972, £722 786). Conclusions: Specialist rehabilitation proved highly cost-efficient for severely disabled patients with TBI, despite their reduced life-span, potentially generating over £4 billion savings in the cost of ongoing care for this 8-year national cohort.
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Hwang S, Kim A, Moon S, Kim J, Kim J, Ha Y, Yang O. The Development of Korean Rehabilitation Patient Group Version 1.0. HEALTH POLICY AND MANAGEMENT 2016. [DOI: 10.4332/kjhpa.2016.26.4.289] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
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Maribo T, Pedersen AR, Jensen J, Nielsen JF. Assessment of primary rehabilitation needs in neurological rehabilitation: translation, adaptation and face validity of the Danish version of Rehabilitation Complexity Scale-Extended. BMC Neurol 2016; 16:205. [PMID: 27769250 PMCID: PMC5073960 DOI: 10.1186/s12883-016-0728-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2016] [Accepted: 10/15/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Assessing primary rehabilitation needs in patients with acquired brain injury is a challenge due to case complexity and the heterogeneity of symptoms after brain injury. The Rehabilitation Complexity Scale-Extended (RCS-E) is an instrument used in assessment of rehabilitation complexity in patients with severe brain injury. The aim of the present study was to translate and test the face validity of the RCS-E as a referral tool for primary rehabilitation. Face validity was tested in a sample of patients with acquired brain injury. METHODS Ten clinicians and records from 299 patients with acquired brain injury were used in the translation, cross-cultural adaptation and face validation study of the RCS-E. RCS-E was translated into Danish by a standardized forward-backward translation by experts in the field. Face validity was assessed by a multi-professional team assessing 299 patients. The team was asked their opinion on whether the RCS-E presents a sufficient description of the patients. RESULTS The RCS-E was translated according to international guidelines and tested by health professionals; some adaptations were required due to linguistic problems and differences in the national health system structures. The patients in the study had a mean age of 63.9 years (SD 14.7); 61 % were male. We found an excellent face validity with a mean score of 8.2 (SD 0.34) assessed on a 0-10 scale. CONCLUSIONS The RCS-E demonstrated to be a valid assessment of primary rehabilitation needs in patients with acquired brain injury. Excellent face validity indicates that the RCS-E is feasible for assessing primary rehabilitation needs and the present study suggests its applicability to the Danish health care system.
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Affiliation(s)
- Thomas Maribo
- Department of Public Health, Section of clinical social medicine and rehabilitation, Aarhus University, Aarhus, Denmark
- DEFACTUM, Central Denmark Region, Aarhus, Denmark
| | - Asger R. Pedersen
- Hammel Neurorehabilitation and Research Centre, Aarhus University, Hammel, Denmark
| | - Jim Jensen
- Hammel Neurorehabilitation and Research Centre, Aarhus University, Hammel, Denmark
| | - Jørgen F. Nielsen
- Hammel Neurorehabilitation and Research Centre, Aarhus University, Hammel, Denmark
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Singh R, Sinha S, Bill A, Turner-Stokes L. Unmet need for specialised rehabilitation following neurosurgery: can we maximise the potential cost–benefits? Br J Neurosurg 2016; 31:249-253. [DOI: 10.1080/02688697.2016.1233318] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
- Rajiv Singh
- Department of Rehabilitation Medicine, Osborn Neurorehabilitation Unit, Sheffield Teaching Hospitals, Sheffield, UK
| | - Saurabh Sinha
- Department of Neurosurgery, Sheffield Teaching Hospitals, Sheffield, UK
| | - Alan Bill
- UK Rehabilitation Outcomes Collaborative (UKROC), London, UK
| | - Lynne Turner-Stokes
- UK Rehabilitation Outcomes Collaborative (UKROC), London, UK
- Department of Palliative Care, Policy and Rehabilitation, Faculty of Life Sciences and Medicine, King’s College London, London, UK
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Turner-Stokes L, Bavikatte G, Williams H, Bill A, Sephton K. Cost-efficiency of specialist hyperacute in-patient rehabilitation services for medically unstable patients with complex rehabilitation needs: a prospective cohort analysis. BMJ Open 2016; 6:e012112. [PMID: 27609852 PMCID: PMC5020841 DOI: 10.1136/bmjopen-2016-012112] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVES 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. DESIGN A multicentre cohort analysis of prospectively collected clinical data from the UK Rehabilitation Outcomes Collaborative (UKROC) national clinical database, 2012-2015. SETTING Two HA specialist rehabilitation services in England, providing different service models for HA rehabilitation. PARTICIPANTS 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%). INTERVENTION Specialist in-patient multidisciplinary rehabilitation combined with management and stabilisation of intercurrent medical and surgical problems. OUTCOME MEASURES 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. RESULTS 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). CONCLUSIONS 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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Affiliation(s)
- Lynne Turner-Stokes
- Department of Palliative Care, Policy and Rehabilitation, Faculty of Life Sciences and Medicine, King's College London, London, UK
- Regional/Hyperacute Rehabilitation Unit, Northwick Park Hospital, Harrow, UK
| | | | - Heather Williams
- Regional/Hyperacute Rehabilitation Unit, Northwick Park Hospital, Harrow, UK
| | - Alan Bill
- Regional/Hyperacute Rehabilitation Unit, Northwick Park Hospital, Harrow, UK
| | - Keith Sephton
- Regional/Hyperacute Rehabilitation Unit, Northwick Park Hospital, Harrow, UK
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Kang JH, Bae HJ, Choi YA, Lee SH, Shin HI. Length of Hospital Stay After Stroke: A Korean Nationwide Study. Ann Rehabil Med 2016; 40:675-81. [PMID: 27606274 PMCID: PMC5012979 DOI: 10.5535/arm.2016.40.4.675] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2015] [Accepted: 01/05/2016] [Indexed: 11/26/2022] Open
Abstract
Objective To investigate the length of hospital stay (LOS) after stroke using the database of the Korean Health Insurance Review & Assessment Service. Methods We matched the data of patients admitted for ischemic stroke onset within 7 days in the Departments of Neurology of 12 hospitals to the data from the database of the Korean Health Insurance Review & Assessment Service. We recruited 3,839 patients who were hospitalized between January 2011 and December 2011, had a previous modified Rankin Scale of 0, and no acute hospital readmission after discharge. The patients were divided according to the initial National Institute of Health Stroke Scale score (mild, ≤5; moderate, >5 and ≤13; severe, >13); we compared the number of hospitals that admitted patients and LOS after stroke according to severity, age, and sex. Results The mean LOS was 115.6±219.0 days (median, 19.4 days) and the mean number of hospitals was 3.3±2.1 (median, 2.0). LOS was longer in patients with severe stroke (mild, 65.1±146.7 days; moderate, 223.1±286.0 days; and severe, 313.2±336.8 days). The number of admitting hospitals was greater for severe stroke (mild, 2.9±1.7; moderate, 4.3±2.6; and severe, 4.5±2.4). LOS was longer in women and shorter in patients less than 65 years of age. Conclusion LOS after stroke differed according to the stroke severity, sex, and age. These results will be useful in determining the appropriate LOS after stroke in the Korean medical system.
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Affiliation(s)
- Ji-Ho Kang
- Department of Rehabilitation Medicine, Seoul National University College of Medicine, Seoul, Korea
| | - Hee-Joon Bae
- Department of Neurology, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Young-Ah Choi
- Department of Rehabilitation Medicine, Seoul National University College of Medicine, Seoul, Korea
| | - Sang Heon Lee
- Department of Physical Medicine and Rehabilitation, Korea University Anam Hospital, Seoul, Korea
| | - Hyung Ik Shin
- Department of Rehabilitation Medicine, Seoul National University College of Medicine, Seoul, Korea
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Pedersen AR, Nielsen JF, Jensen J, Maribo T. Referral decision support in patients with subacute brain injury: evaluation of the Rehabilitation Complexity Scale - Extended. Disabil Rehabil 2016; 39:1221-1227. [PMID: 27384499 DOI: 10.1080/09638288.2016.1189610] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
PURPOSE To test if the Rehabilitation Complexity Scale Extended (RCS-E) can be used as decision support for patient referral to primary rehabilitation as either complex specialized services (CSS) or district specialist services (DSS). METHOD Two independent expert teams analyzed medical records on 299 consecutive patients admitted for CSS or DSS rehabilitation. One team provided a golden standard for the patient referrals, and the other team provided RCS-E scores. Models for predicting referrals from RCS-E scores were developed on data for 149 patients and tested on the remaining 150 patients. RESULTS The optimal RCS-E sum score threshold for referral prediction was 11, predicting the golden standard for patient referral with sensitivity 88%, specificity 78% and correct classification rate 81%. Improved referral prediction performance was achieved by using RCS-E item-wise score thresholds (sensitivity 81%, specificity 89%, correct classification rate 87%). The RCS-E sum score range for patients referred CSS and DSS by the item-wise model was, respectively, 0-12 and 2-22 suggesting strong non-linear interaction of the RCS-E items. CONCLUSIONS We found excellent referral decision support in the RCS-E and the item specific threshold model, when patients with acquired brain injury are to be referred to CSS or DSS as their primary rehabilitation. Implications for Rehabilitation Efficient rehabilitation after acquired brain injury requires rehabilitation settings that meet patient needs. Validated tools for referral decision support make the process more transparent. Patient rehabilitation complexity can be stratified by the RCS-E with high sensitivity, specificity and predictive value of positive test. RCS-E is an excellent tool for referral decision support.
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Affiliation(s)
- Asger R Pedersen
- a Hammel Neurorehabilitation and Research Centre , Aarhus University , Hammel , Denmark
| | - Jørgen F Nielsen
- a Hammel Neurorehabilitation and Research Centre , Aarhus University , Hammel , Denmark
| | - Jim Jensen
- a Hammel Neurorehabilitation and Research Centre , Aarhus University , Hammel , Denmark
| | - Thomas Maribo
- b Department of Public Health, Rehabilitation Center Marselisborg, Section of Clinical Social Medicine and Rehabilitation , Aarhus University , Aarhus , Denmark.,c DEFACTUM, Central Denmark Region , Aarhus , Denmark
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Clark-Wilson J, Giles GM, Seymour S, Tasker R, Baxter DM, Holloway M. Factors influencing community case management and care hours for clients with traumatic brain injury living in the UK. Brain Inj 2016; 30:872-82. [PMID: 27058173 PMCID: PMC4926787 DOI: 10.3109/02699052.2016.1146799] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVE To investigate the relationship between deficits associated with traumatic brain injury (TBI) and case management (CM) and care/support (CS) in two UK community samples. RESEARCH DESIGN Prospective descriptive study. METHOD Case managers across the UK and from a single UK CM service contributed client profiles to two data sets (Groups 1 and 2, respectively). Data were entered on demographics, injury severity, functional skills, functional-cognition (including executive functions), behaviour and CM and CS hours. Relationships were explored between areas of disability and service provision. RESULTS Clients in Group 2 were more severely injured, longer post-injury and had less family support than clients in Group 1. There were few significant differences between Groups 1 and 2 on measures of Functionalskill, Functional-cognition and Behaviour disorder. Deficits in Functionalskills were associated with CS, but not CM. Deficits in measures of executive functions (impulsivity, predictability, response to direction) were related to CM, but not to CS. Insight was related to both CM and CS. Variables related to behaviour disorder were related to CM, but were less often correlated to CS. CONCLUSIONS The need for community support is related not only to Functionalskills (CS), but also to behaviour disorder, self-regulatory skills and impaired insight (CM).
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Affiliation(s)
| | - Gordon Muir Giles
- b Samuel Merritt University , Oakland , CA , USA.,c Crestwood Treatment Center , Fremont , CA , USA
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Turner-Stokes L, Williams H, Bill A, Bassett P, Sephton K. Cost-efficiency of specialist inpatient rehabilitation for working-aged adults with complex neurological disabilities: a multicentre cohort analysis of a national clinical data set. BMJ Open 2016; 6:e010238. [PMID: 26911586 PMCID: PMC4769383 DOI: 10.1136/bmjopen-2015-010238] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
OBJECTIVES To 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. DESIGN A multicentre cohort analysis of prospectively collected clinical data from the UK Rehabilitation Outcomes Collaborative (UKROC) national clinical database, 2010-2015. SETTING All 62 specialist (levels 1 and 2) rehabilitation services in England. PARTICIPANTS Working-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%). INTERVENTION Specialist inpatient multidisciplinary rehabilitation. OUTCOME MEASURES Dependency 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. RESULTS Mean 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. CONCLUSIONS Specialist rehabilitation can be highly cost-efficient for all neurological conditions, producing substantial savings in ongoing care costs, especially in high-dependency patients.
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Affiliation(s)
- Lynne Turner-Stokes
- Faculty of Life Sciences and Medicine, Department of Palliative Care, Policy and Rehabilitation, King's College London, London, UK
- Regional/Hyper-acute Rehabilitation Unit, Northwick Park Hospital, UK
| | - Heather Williams
- Regional/Hyper-acute Rehabilitation Unit, Northwick Park Hospital, UK
| | - Alan Bill
- Regional/Hyper-acute Rehabilitation Unit, Northwick Park Hospital, UK
| | | | - Keith Sephton
- Regional/Hyper-acute Rehabilitation Unit, Northwick Park Hospital, UK
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Galletti L, Benedetti MG, Maselli S, Zanoli G, Pignotti E, Iovine R. Rehabilitation Complexity Scale: Italian translation and transcultural validation. Disabil Rehabil 2015; 38:87-96. [DOI: 10.3109/09638288.2015.1024340] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Alexandrescu R, Siegert RJ, Turner-Stokes L. The Northwick Park Therapy Dependency Assessment scale: a psychometric analysis from a large multicentre neurorehabilitation dataset. Disabil Rehabil 2015; 37:1976-83. [PMID: 25598001 PMCID: PMC4720035 DOI: 10.3109/09638288.2014.998779] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Purpose: To assess the internal reliability, construct and concurrent validity and responsiveness of the Northwick Park Therapy Dependency Assessment (NPTDA) scale. Method: A cohort of 2505 neurorehabilitation patients submitted to the UK Rehabilitation Outcomes Collaborative database. Cronbach’s coefficient-α was used to assess internal reliability and factor analysis (FA) to assess construct validity. We compared NPTDA scores at admission and discharge to determine responsiveness. Results: Coefficient-α for the whole scale was 0.74. The exploratory FA resulted in a four-factor model (Physical, Psychosocial, Discharge planning and Activities) that accounted for 43% of variance. This model was further supported by the confirmatory FA. The final model had a good fit: root-mean-square error of approximation of 0.069, comparative fit index/Tucker–Lewis index of 0.739/0.701 and the goodness of fit index of 0.909. The NPTDA scores at admission and discharge were significantly different for each of the factors. Expected correlations were seen between the admission scores for the NPTDA, the Rehabilitation Complexity Scale (r = 0.30, p < 0.01) and the Functional Independence Measure (r = −0.25, p < 0.01). Conclusions: The scale demonstrated acceptable internal reliability and good construct and concurrent validity. NPTDA may be used to describe and quantify changes in therapy inputs in the course of a rehabilitation programme.Implications for Rehabilitation The Northwick Park Therapy Dependency Assessment (NPTDA) is designed as a measure therapy intervention, which reflects both quantitative and qualitative aspects of the inputs provided (including staff time and the different types of intervention) during inpatient rehabilitation. The scale demonstrated acceptable internal reliability and good construct and concurrent validity. NPTDA is responsive to change in the therapy inputs provided during neurorehabilitation between admission and discharge.
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Affiliation(s)
- Roxana Alexandrescu
- a Department of Palliative Care, Policy and Rehabilitation , School of Medicine, King's College London , London , UK
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Troigros O, Béjot Y, Rodriguez PM, Shoaib F, Ellis H, Wade D. Measuring complexity in neurological rehabilitation: the Oxford Case Complexity Assessment Measure (OCCAM). Clin Rehabil 2013; 28:499-507. [DOI: 10.1177/0269215513505300] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Objective: To investigate validity and reliability of a new measure of case complexity, the Oxford Case Complexity Assessment Measure (OCCAM). Design: Data collection on inpatients and outpatients attending for rehabilitation. In subsets, repeat assessments were undertaken two weeks apart, by clinicians unaware of initial data, and on admission and on discharge from inpatient rehabilitation. Setting: Specialist neurological rehabilitation service. Subjects: Patients receiving rehabilitation after acute onset disability. Interventions: Assessment by clinical staff as part of routine care. Measures: OCCAM, the INTERMED, Rehabilitation Complexity Scale – Extended (RCS-E), clinical judgement of complexity (0–10 numerical rating scale), length of stay and discharge destination (for inpatients). Results: For the OCCAM, the Cronbach’s α coefficient was 0.69 and item-total correlations were moderate to high except for pathology and time. The correlation coefficients with OCCAM were: INTERMED (ρ = 0.694), RCS-E (ρ = 0.736), and team judgement (ρ = 0.796). Inter-rater agreement was excellent (Weighted κ = 0.95). Correlation between admission and discharge scores was ρ = 0.917. Test–retest agreement was good (intraclass correlation coefficient 0.86). Higher mean admission scores were associated with prolonged stays (38.6 ± 12.2 versus 32.9 ± 13.7, P = 0.04) and failure to return home (48.0 ± 13.7 versus mean 32.1 ± 10.7, P < 0.001). The optimal cut-off of OCCAM to detect patients not discharged home was ≥ 34, with corresponding sensitivity and specificity of 84.6% and 62.8%, respectively. Conclusions: This preliminary evidence suggests that the OCCAM may measure case complexity reliably, and may predict rehabilitation resource used and outcome. Further research is warranted.
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Affiliation(s)
| | - Yannick Béjot
- University Hospital and Medical School of Dijon, Dijon, France
| | | | - Farhat Shoaib
- Oxford Centre for Enablement, Nuffield Orthopaedic Centre, Oxford, UK
| | - Henrietta Ellis
- Oxford Centre for Enablement, Nuffield Orthopaedic Centre, Oxford, UK
| | - Derick Wade
- Oxford Centre for Enablement, Nuffield Orthopaedic Centre, Oxford, UK
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Murtagh FE, Iris Groeneveld E, Kaloki YE, Calanzani N, Bausewein C, Higginson IJ. Capturing activity, costs, and outcomes: The challenges to be overcome for successful economic evaluation in palliative care. PROGRESS IN PALLIATIVE CARE 2013. [DOI: 10.1179/1743291x12y.0000000046] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
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17
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Abstract
Purpose: To evaluate the psychometric properties of the UK FIM + FAM. Methods: (a) A systematic literature review integrating the evidence for psychometric qualities of both the original and UK versions, and (b) exploratory and confirmatory factor analysis of admission/discharge data from an inpatient general neuro-rehabilitation cohort using parametric and non-parametric techniques. A prospective cohort of 459 patients with a male:female ratio of 57:43 and mean age of 44.5 (SD 14.3) years participated in this study. Results: Seven published articles together demonstrated acceptable utility, concurrent validity, inter-rater reliability and responsiveness of the UK FIM + FAM. Factor analysis demonstrated that all items loaded high (>0.58) on the first principal component and distinct motor and cognitive factors emerged after rotation. A four-factor solution also demonstrated four distinct, interpretable dimensions (Physical, Psychosocial, Communication and Extended Activities of Everyday Living (EADL)). Mokken analysis of the second data set confirmed these dimensions. Cronbach’s αs were 0.97 and 0.96 for the motor and cognitive domains and 0.90–0.97 for the subscales. Analysis of responsiveness demonstrated “large” effect sizes (0.86–1.29). Conclusions: The UK FIM + FAM, including the newer EADL module, is a valid, reliable scale of functional independence. It has high internal consistency in two domains and four subscales and is responsive to changes occurring in a general inpatient neuro-rehabilitation population.
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Affiliation(s)
- Lynne Turner-Stokes
- King's College London, School of Medicine, Department of Palliative Care, Policy and Rehabilitation , London , UK
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Beggs AD, McGlone ER, Thomas PRS. Impact of centralisation on vascular surgical services. ACTA ACUST UNITED AC 2012. [DOI: 10.12968/bjhc.2012.18.9.468] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Affiliation(s)
- Andrew D Beggs
- Department of Surgery Epsom & St Helier Hospital NHS Trust
| | | | - Paul RS Thomas
- Department of Surgery Epsom & St Helier Hospital NHS Trust
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Turner-Stokes L, Williams H, Sephton K, Rose H, Harris S, Thu A. Engaging the hearts and minds of clinicians in outcome measurement - the UK Rehabilitation Outcomes Collaborative approach. Disabil Rehabil 2012; 34:1871-9. [PMID: 22506959 PMCID: PMC3477889 DOI: 10.3109/09638288.2012.670033] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
PURPOSE This article explores the rationale for choosing the instruments included within the UK Rehabilitation Outcomes Collaborative (UKROC) data set. Using one specialist neuro-rehabilitation unit as an exemplar service, it describes an approach to engaging the hearts and minds of clinicians in recording the data. KEY MESSAGES AND IMPLICATIONS Measures included within a national data set for rehabilitation should be psychometrically robust and feasible to use in routine clinical practice; they should also support clinical decision-making so that clinicians actually want to use them. Learning from other international casemix models and benchmarking data sets, the UKROC team has developed a cluster of measures to inform the development of effective and cost-efficient rehabilitation services. These include measures of (1) "needs" for rehabilitation (complexity), (2) inputs provided to meet those needs (nursing and therapy intervention), and (3) outcome, including the attainment of personal goals as well as gains in functional independence. CONCLUSIONS By integrating the use of the data set measures in everyday clinical practice, we have achieved a very high rate of compliance with data collection. However, staff training and ongoing commitment from senior staff and managers are critical to the maintenance of effort required to provide assurance of data quality in the longer term.
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Affiliation(s)
- Lynne Turner-Stokes
- King's College London School of Medicine, Department of Palliative Care, Policy and Rehabilitation, London, UK.
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Turner-Stokes L, Poppleton R, Williams H, Schoewenaars K, Badwan D. Using the UKROC dataset to make the case for resources to improve cost-efficiency in neurological rehabilitation. Disabil Rehabil 2012; 34:1900-6. [PMID: 22506504 PMCID: PMC3477888 DOI: 10.3109/09638288.2012.670042] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022]
Abstract
Purpose A key challenge for providers and commissioners of rehabilitation services is to find optimal balance between service costs and outcomes. This article presents a “real-lifeâ application of the UK Rehabilitation Outcomes Collaborative (UKROC) dataset. We undertook a comparative cohort analysis of case-episode data (n = 173) from two specialist neurological rehabilitation units (A and B), to compare the cost-efficiency of two service models. Key messages (i) Demographics, casemix and levels of functional dependency on admission and discharge were broadly similar for the two units. (ii) The mean length of stay for Unit A was 1.5 times longer than Unit B, which had 85% higher levels of therapy staffing in relation to occupied bed days so despite higher bed-day costs, Unit B was 20% more cost-efficient overall, for similar gain. (iii) Following analysis, engagement with service commissioners led to successful negotiation of a business plan for service reconfiguration with increased staffing levels for Unit A and further development of local community rehabilitation services. Conclusion (i) Lower front-end service costs do not always signify optimal cost-efficiency. (ii) Analysis of routinely collected clinical data can be used to engage commissioners and to make the case for resources to maximise efficiency and improve patient care.
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Affiliation(s)
- Lynne Turner-Stokes
- King's College London School of Medicine, Department of Palliative Care Policy and Rehabilitation, London, UK.
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