King's College London School of Medicine, Department of Palliative Care Policy and Rehabilitation, London, UK.
Disabil Rehabil. 2012;34(22):1900-6. doi: 10.3109/09638288.2012.670042. Epub 2012 Apr 16.
A key challenge for providers and commissioners of rehabilitation services is to find optimal balance between service costs and outcomes. This article presents a "real-life" application of the UK Rehabilitation Outcomes Collaborative (UKROC) dataset. We undertook a comparative cohort analysis of case-episode data (n = 173) from two specialist neurological rehabilitation units (A and B), to compare the cost-efficiency of two service models.
(i) Demographics, casemix and levels of functional dependency on admission and discharge were broadly similar for the two units. (ii) The mean length of stay for Unit A was 1.5 times longer than Unit B, which had 85% higher levels of therapy staffing in relation to occupied bed days so despite higher bed-day costs, Unit B was 20% more cost-efficient overall, for similar gain. (iii) Following analysis, engagement with service commissioners led to successful negotiation of a business plan for service reconfiguration with increased staffing levels for Unit A and further development of local community rehabilitation services.
(i) Lower front-end service costs do not always signify optimal cost-efficiency. (ii) Analysis of routinely collected clinical data can be used to engage commissioners and to make the case for resources to maximise efficiency and improve patient care.
对于康复服务的提供者和决策者来说，一个关键的挑战是在服务成本和结果之间找到最佳平衡。本文介绍了英国康复成果协作组织（UKROC）数据集的“实际应用”。我们对来自两个专门的神经康复单位（A 和 B）的病例数据（n=173）进行了比较队列分析，以比较两种服务模式的成本效益。
（i）两个单位的人口统计学、病例组合和入院时及出院时的功能依赖程度大致相似。（ii）A 单位的平均住院时间比 B 单位长 1.5 倍，B 单位的治疗人员配备与占用床位天数的比例高 85%，因此尽管床位日成本较高，但 B 单位的整体成本效益提高了 20%，获得了相似的收益。（iii）经过分析，与服务决策者的接触促成了成功谈判，为 A 单位增加人员配置制定了服务重组业务计划，并进一步发展了当地社区康复服务。
（i）较低的前端服务成本并不总是意味着最佳的成本效益。（ii）对常规收集的临床数据进行分析，可以用来与决策者接触，并为资源争取最大效率和改善患者护理提供依据。
