An Outreach Rehabilitation Program for Nursing Home Residents After Hip Fracture May Be Cost-Saving

Journals of Gerontology - Series A Biological Sciences and Medical Sciences - Tập 75 Số 10 - Trang e159-e165 - 2020
Lauren A Beaupré1,2, Doug Lier3, Jay Magaziner4, C Allyson Jones1, D. W. C. Johnston2, Donna M. Wilson5,6, Sumit R. Majumdar3
1Department of Physical Therapy, University of Alberta, Edmonton, Canada
2Department of Surgery, University of Alberta, Edmonton, Canada
3Department of Medicine University of Alberta, Edmonton, Canada
4Department of Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore
5Faculty of Education and Health Sciences, University of Limerick, Ireland
6Faculty of Nursing, University of Alberta, Edmonton, Canada

Tóm tắt

AbstractBackgroundWe compared the cost-effectiveness of 10 weeks of outreach rehabilitation (intervention) versus usual care (control) for ambulatory nursing home residents after hip fracture.MethodsEnrollment occurred February 2011 through June 2015 in a Canadian metropolitan region. Seventy-seven participants were allocated in a 2:1 ratio to receive a 10-week rehabilitation program (intervention) or usual care (control) (46 intervention; 31 control). Using a payer perspective, we performed main and sensitivity analyses. Health outcome was measured by quality-adjusted life years (QALYs), using the EQ5D, completed at study entry, 3-, 6-, and 12-months. We obtained patient-specific data for outpatient visits, physician claims, and inpatient readmissions; the trial provided rehabilitation utilization/cost data. We estimated incremental cost and incremental effectiveness.ResultsGroups were similar at study entry; the mean age was 87.9 ± 6.6 years, 54 (71%) were female and 58 (75%) had severe cognitive impairment. EQ5D QALYs scores were nonsignificantly higher for intervention participants. Inpatient readmissions were two times higher among controls, with a cost difference of −$3,350/patient for intervention participants, offsetting the cost/intervention participant of $2,300 for the outreach rehabilitation. The adjusted incremental QALYs/patient difference was 0.024 favoring the intervention, with an incremental cost/patient of −$621 for intervention participants; these values were not statistically significant. A sensitivity analysis reinforced these findings, suggesting that the intervention was likely dominant.ConclusionA 10-week outreach rehabilitation intervention for nursing home residents who sustain a hip fracture may be cost-saving, through reduced postfracture hospital readmissions. These results support further work to evaluate postfracture rehabilitation for nursing home residents.

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Journals of Gerontology - Series A Biological Sciences and Medical Sciences

Tập 75 Số 10

e159-e165

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