Is weekend inpatient rehabilitation value for money?
There is debate about the potential advantages to patients and health care facilities providing rehab services on the weekend, as opposed to hospitals, A&E and ICU.
The proposed advantages of providing weekend health services include improved clinical outcomes for patients and fewer adverse events among those admitted on the weekend. Doubt exists if weekend services are safe and effective, there is debate about working in the weekend, where the allied health system is already under strain, and patients would need their time to rest and recover from an intensive program during the week.
Rehabilitation is specialized, coordinated, multidisciplinary care to restore functional independence in patients; more intensive therapy leads to improved QoL and reduces length of stay. This may be related to increased physical activity, reduced functional decline, and patient motivation. However, very few rehab facilities do provide weekend services.
In the debate on whether to provide weekend health services, the issue of who will pay and whether providing such services is cost effective is central.
An RCT was started in two publicly funded rehab facilities in Melbourne for 996 patients with any orthopedic, neurological or other disabling condition. Intervention was simply and extra day (Saturday) of the normal rehab interventions during the week; 1 hour of PT and one hour of OT, excluding other allied health services or medical appointments.
Outcome measures were LoS (nights), units of therapy (min), costs (AUD$), QoL (EQ-5D-3L), and functional independence (FIM).
The results show a significant improvement in both outcome measures (QoL, hours of therapy, and functional indepence) as well as a difference in LoS and costs in favor of the provision of an extra Saturday session.
Secondly, the flow of patients was improved, by being able to start the rehab process on admission on a Saturday, thereby further reducing costs.
When considering the health service perspective, it is reported that in the inpatient rehabilitation setting the patient length of stay is the largest contributor to health care costs; implementing weekend services can reduce those costs, while improving outcome - a win-win situation
> From: Brusco et al., BMC Med 12 (2015) 89. All rights reserved to Biomed Central Ltd. Click here for the Pubmed summary.