HammondCare, Sydney, Australia.
School of Population Health, UNSW, Sydney, Australia.
BMC Health Serv Res. 2024 Jan 30;24(1):151. doi: 10.1186/s12913-023-10527-2.
Inpatient rehabilitation services are challenged by increasing demand. Where appropriate, a shift in service models towards more community-oriented approaches may improve efficiency. We aimed to estimate the hypothetical cost of delivering a consensus-based rehabilitation in the home (RITH) model as hospital substitution for patients requiring reconditioning following medical illness, surgery or treatment for cancer, compared to the cost of inpatient rehabilitation.
Data were drawn from the following sources: the results of a Delphi survey with health professionals working in the field of rehabilitation in Australia; publicly available data and reports; and the expert opinion of the project team. Delphi survey data were analysed descriptively. The costing model was developed using assumptions based on the sources described above and was restricted to the Australian National Subacute and Non-Acute Patient Classification (AN-SNAP) classes 4AR1 to 4AR4, which comprise around 73% of all reconditioning episodes in Australia. RITH cost modelling estimates were compared to the known cost of inpatient rehabilitation. Where weighted averages are provided, these were determined based on the modelled number of inpatient reconditioning episodes per annum that might be substitutable by RITH.
The cost modelling estimated the weighted average cost of a RITH reconditioning episode (which mirrors an inpatient reconditioning episode in intensity and duration) for AN-SNAP classes 4AR1 to 4AR4, to be A$11,371, which is 28.1% less than the equivalent weighted average public inpatient cost (of A$15,820). This represents hypothetical savings of A$4,449 per RITH reconditioning substituted episode of care.
The hypothetical cost of a model of RITH which would provide patients with as comprehensive a rehabilitation service as received in inpatient rehabilitation, has been determined. Findings suggest potential cost savings to the public hospital sector. Future research should focus on trials which compare actual clinical and cost outcomes of RITH for patients in the reconditioning impairment category, to inpatient rehabilitation.
住院康复服务面临需求增加的挑战。在适当的情况下，将服务模式向更以社区为导向的方法转变，可能会提高效率。我们旨在估算基于共识的家庭康复（RITH）模式为需要在疾病、手术或癌症治疗后重新适应的患者提供替代住院康复服务的假设成本，与住院康复的成本相比。
数据来自以下来源：澳大利亚康复领域卫生专业人员德尔菲调查的结果；公开数据和报告；以及项目团队的专家意见。德尔菲调查数据进行了描述性分析。成本模型的开发是基于上述来源的假设，并仅限于澳大利亚国家亚急性和非急性患者分类（AN-SNAP）等级 4AR1 到 4AR4，这占澳大利亚所有康复治疗的 73%左右。RITH 成本建模估计与已知的住院康复成本进行了比较。如果提供加权平均值，则这些平均值是根据每年可能通过 RITH 替代的住院康复治疗的建模数量确定的。
成本建模估计了 AN-SNAP 等级 4AR1 到 4AR4 的 RITH 康复治疗的加权平均成本（与住院康复治疗的强度和持续时间相同）为 11371 澳元，比等效的加权平均公共住院费用（15820 澳元）低 28.1%。这代表每替代一个 RITH 康复治疗的护理治疗节余 4449 澳元。
已经确定了为患者提供与住院康复治疗相同全面康复服务的 RITH 模型的假设成本。研究结果表明，公共医院部门有潜在的成本节约。未来的研究应侧重于比较 RITH 对康复治疗类患者的实际临床和成本结果与住院康复的试验。
