In-patient rehabilitation: clinical outcomes and cost implications.

Mel Bunyan,Ehab Morgan,Yogesh Ganeshalingam,Donvé Thompson-Boy,Rebekah Wigton,Frank Holloway,Derek K Tracy

doi:10.1192/pb.bp.114.049858

Abstract

Aims and method A retrospective evaluation was undertaken of the clinical and economic effectiveness of three in-patient rehabilitation units across one London National Health Service trust. Information on admission days and costs 2 years before and 2 years after the rehabilitation placement, length of rehabilitation placement and the discharge pathway was collected on 22 service users.Results There were statistically significant reductions in hospital admission days in the 2 years following rehabilitation compared with the 2 years before, further reflected in significantly lower bed costs. Longer length of rehabilitation placement was correlated with fewer admission days after the placement. A substantial proportion of the sample went into more independent living, some with no further admissions at follow-up.Clinical implications The findings suggest that in-patient rehabilitation is both clinically and cost effective: if benefits are sustained they will offset the cost of the rehabilitation placement.

Highlights

Clinical implications The findings suggest that in-patient rehabilitation is both clinically and cost effective: if benefits are sustained they will offset the cost of the rehabilitation placement
A limited evidence base exists for in-patient rehabilitation services
About 80% of rehabilitation services users have a primary diagnosis of psychosis,[11] and the rationale for input may include treatment resistance, comorbidities such as neurodevelopmental disorders and substance misuse, behavioural disturbances, and an inability to effect discharge from an acute ward.[12]

Summary

Results

The five individuals who had been in continuous admission for the 2 years before rehabilitation remained in rehabilitation care longer than average Of this subgroup four were discharged to residential care, one to an independent flat, and three had no admissions in the follow-up period. Five individuals required 3-4 years of rehabilitation input, and this subgroup continued to require a substantial amount of post-discharge care, with four discharged into residential care, none were readmitted in the 2year follow-up period. . Duration of care was negatively correlated with the number of admission days post-rehabilitation (rs = 70.55, P = 0.008). Post-rehabilitation half the sample had no major risk incidents in the follow-up period, five had one major risk incident, four had two such incidents, and two individuals had four major risk events

Method

Participants

Procedure

Discussion

Limitations