Turner-Stokes L, Paul S, Williams H
Regional Rehabilitation Unit, Northwick Park Hospital, Watford Road, Harrow, Middlesex HA1 3UJ, and Department of Palliative Care, Policy and Rehabilitation, King's College London School of Medicine, UK.
J Neurol Neurosurg Psychiatry. 2006 May;77(5):634-9. doi: 10.1136/jnnp.2005.073411.
To examine functional outcomes from a rehabilitation programme and to compare two methods for evaluating cost efficiency of rehabilitation in patients with severe complex disability.
Two hundred and ninety seven consecutive admissions to a specialist inpatient rehabilitation unit following severe acquired brain injury.
Retrospective analysis of routinely collected data, including the Functional Independence Measure (FIM), Barthel Index, and Northwick Park Dependency Score and Care Needs Assessment (NPDS/NPCNA), which provides a generic estimation of dependency, care hours. and weekly cost of continuing care in the community. Patients were analysed in three groups according to dependency on admission: "low" (NPDS<10 (n=83)); "medium" (NPDS10-24 (n=112)); "high" (NPDS>24 (n=102)).
Mean length of stay (LOS) 112 (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 cost of care" was greatest in the high dependency group at pound639 per week (95% CI 488 to 789)), as compared with the medium (pound323/week (95% CI 217 to 428)), and low (pound111/week (95% CI 42 to 179)) dependency groups. Despite their longer LOS, time taken to offset the initial cost of rehabilitation was only 16.3 months in the high dependency group, compared with 21.5 months (medium dependency) and 38.8 months (low dependency). FIM efficiency (FIM gain/LOS) appeared greatest in the medium dependency group (0.25), compared with the low (0.17) and high (0.16) dependency groups.
The NPDS/NPCNA detected changes in dependency potentially associated with substantial savings in the cost of ongoing care, especially in high dependency patients. Floor effects in responsiveness of the FIM may lead to underestimation of efficiency of rehabilitation in higher dependency patients.
研究康复计划的功能结局，并比较两种评估重度复杂残疾患者康复成本效益的方法。
297例因严重后天性脑损伤而连续入住专科住院康复单元的患者。
对常规收集的数据进行回顾性分析，包括功能独立性测量（FIM）、巴氏指数、诺斯威克公园依赖评分和护理需求评估（NPDS/NPCNA），该评估提供了对依赖程度、护理时长和社区持续护理每周成本的一般估计。根据入院时的依赖程度将患者分为三组：“低”（NPDS<10（n = 83））；“中”（NPDS 10 - 24（n = 112））；“高”（NPDS>24（n = 102））。
平均住院时长（LOS）为112（标准差66）天。所有组在所有测量指标上入院时与出院时的依赖程度均显著降低（配对t检验：p<0.001）。“每周护理成本”的平均降低幅度在高依赖组最大，为每周639英镑（95%置信区间488至789），相比之下，中依赖组为每周323英镑（95%置信区间217至428），低依赖组为每周111英镑（95%置信区间42至179）。尽管高依赖组住院时间更长，但抵消康复初始成本所需的时间仅为16.3个月，而中依赖组为21.5个月，低依赖组为38.8个月。FIM效率（FIM增益/LOS）在中依赖组似乎最高（0.25），相比之下，低依赖组为0.17，高依赖组为0.16。
NPDS/NPCNA检测到依赖程度的变化可能与持续护理成本的大幅节省相关，尤其是在高依赖患者中。FIM反应性的下限效应可能导致对高依赖患者康复效率的低估。
