Structured Abstract
Multiple Sclerosis Structured Abstract - MS #13
Hospitalization in a rehabilitation facility compared with acute care is not necessarily more cost effective than acute care hospitalization.
CITATION: Reding, M. J., LaRocca, N., & Madonna, M. (1987). Acute-hospital care versus rehabilitation hospitalization for management of nonemergent complications in multiple sclerosis. Journal of Neurological Rehabilitation, 1, 13-17.
LEVEL OF EVIDENCE: IIB3a
RESEARCH OBJECTIVE/QUESTION
"The goals of the study were: (a) to determine if there was any difference over the long term in hospital readmissions and need for home health aide assistance between patients admitted to an acure-care hospital and those admitted to a rehabilitation facility; and (b) to study the cost-effectiveness of these two forms of hospital care" (p. 14).
DESIGN
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RCT |
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Single Case |
x |
Case Control |
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Cohort |
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Before-After |
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Cross Sectional |
The records of clients with MS admitted to an acute care hospital and a rehabilitation hospital in 1981 and 1982 were reviewed. 36 acute care clients were identified whose overall admitting problems were believed to be such that they could have been treated equally successfully in a rehabilitation setting. Of these 36, a successful match for gender and severity of MS was made with 24 clients admitted to a rehabilitation setting. All participants were contacted by telephone approximately 16 months after the admission to provide information about costs and outcomes. 14 pairs had complete data to questions about costs and outcomes.
SAMPLING PROCEDURE
Chart review and matching (judgmental sample)
SAMPLE
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N = 28 |
Mean age = NR |
Male = NR |
Female = NR |
NR = Not reported
OUTCOMES
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x |
Life roles |
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Tasks |
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Activities |
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Abilities/habits |
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Capacities |
OUTCOME AREAS
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Outcome Area |
Measures |
Reliability |
Validity |
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Incapacity status |
Incapacity Status Scale of the Multiple Sclerosis Minimal Record of Disability |
NR |
NR |
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# of subsequent admissions |
Self-report |
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|
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Cost of home aid |
Self-report and estimate |
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Cost of subsequent hospitalizations |
Self-report and estimate |
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Total follow-up cost of care |
Self-report and estimate |
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NR=Not Reported
INTERVENTION
Description
None - retrospective
Who delivered
N/A
Setting
N/A
Frequency
N/A
Duration
N/A
RESULTS
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|
Acute care |
Rehabilitation |
|
Avg. admission costs |
$8,750
($625 per day/
14 days) |
$12,740
($364 per day/
35 days) |
|
Incapacity status scale (16 months) |
23.93 |
25 |
|
# of subsequent admissions |
1.36 |
.86 |
|
Cost of home aid |
$18,831.50 |
$20,273.14 |
|
Cost of subsequent hospitalization |
$11,875 |
$7,500 |
|
Total follow-up costs |
$30,706.50 |
$27,773.14 |
t-test suggests no significant difference between acute and rehabilitation (no test done for difference in avg. admission cost).
CONCLUSIONS
Biases - recall, sample size, dropouts
Post-hospitalization differences between acute and rehabilitation admissions for clients who could have been in rehabilitation hospitals only were basically the same, although there was a trend for rehabilitation admissions to be cheaper.
Limitations
- Small sample size.
- Self-report of much of the information. Article stated it was "vague."
- Can't demonstrate "no" difference statistically.
- Lost 10 pairs to incomplete information and death.
- Functional status not really explored.
COMMENTARY
Rehabilitation admissions do not appear to significantly reduce the cost of home care. Occupational therapists should evaluate the effect of rehab on home care costs more thoroughly.
Terminology used in this document is based on two systems of classification current at the time the evidence-based literature reviews were completed: Uniform Terminology for Occupational Therapy Practice-Third Edition (AOTA, 1994) and International Classification of Functioning, Disability and Health (ICIDH-2) (World Health Organization [WHO], 1999). More recently, the Uniform Terminology document was replaced by Occupational Therapy Practice Framework: Domain and Process (AOTA, 2002), and modifications to ICIDH-2 were finalized in the International Classification of Functioning, Disability and Health (WHO, 2001).
This work is based on the evidence-based literature review completed by Nancy Baker, ScD, OTR, and Linda Tickle-Degnen, PhD, OTR/L, FAOTA.
For more information about the Evidence-Based Literature Review Project, contact the Practice Department at the American Occupational Therapy Association, 301-652-6611, x 2040.
Copyright 2003 American Occupational Therapy Association, Inc. All rights reserved. This material may be reproduced and distributed without prior written consent.
