Unmet need for specialised rehabilitation following neurosurgery: can we maximise the potential cost–benefits?

Abstract

Objective: To identify the needs for specialised rehabilitation provision in a cohort of neurosurgical patients; to determine if these were met, and to estimate the potential cost implications and cost–benefits of meeting any unmet rehabilitation needs.

Methods: A prospective study of in-patient admissions to a regional neurosurgical ward. Assessment of needs for specialised rehabilitation (Category A or B needs) was made with the Patient Categorisation Tool. The number of patients who were referred and admitted for specialised rehabilitation was calculated. Data from the unit’s submission to the UK Rehabilitation Outcomes Collaborative (UKROC) national clinical database 2012–2015 were used to estimate the potential mean lifetime savings generated through reduction in the costs of on-going care in the community.

Results: Of 223 neurosurgical in-patients over 3 months, 156 (70%) had Category A or B needs. Out of the 105 patients who were eligible for admission to the local specialised rehabilitation service, only 20 (19%) were referred and just 11 (10%) were actually admitted. The mean transfer time was 70.2 (range 28–127) days, compared with the national standard of 42 days. In the 3-year sample, mean savings in the cost of on-going care were £568 per week. Assuming a 10-year reduction in life expectancy, the approximate net lifetime saving for post-neurosurgical patients was estimated as at least £600K per patient. We calculated that provision of additional bed capacity in the specialist rehabilitation unit could generate net savings of £3.6M/bed-year.

Conclusion: This preliminary single-centre study identified a considerable gap in provision of specialised rehabilitation for neurosurgical patients, which must be addressed if patients are to fulfil their potential for recovery. A 5-fold increase in bed capacity would cost £9.3m/year, but could lead to potential net savings of £24m/year. Our findings now require confirmation on a wider scale through prospective multi-centre studies.

Keywords:

• Rehabilitation
• outcome measurement
• dependency
• cost-efficiency
• neurological conditions

Acknowledgements

Special thanks are due to Keith Sephton for assistance with collation of the UKROC data and to Sharon Kilner for her organisation of notes, records and typing the manuscript.

Disclosure statement

There are no significant competing personal interests, other than the general desire of clinicians to demonstrate the effectiveness of services and to improve the overall quality of care offer to our patients. R.S. is the consultant rehabilitation physician of the specialised rehabilitation service whose data are reported here, but he is an NHS Employee with no personal financial interests in the service. S.S. is a consultant neurosurgeon with special interest in rehabilitation provision and audit. He is also an NHS Employee with no personal financial interests in the service.

Outcome measurement is a specific research interest of UKROC. L.T.-S. is Director of UKROC and was the lead developer of the NPDS, NPCNA and the UK FIM + FAM, but neither she nor her employing institution has any financial interest in the tools which are disseminated free of charge. None of the authors have any personal financial interests in the work undertaken or the findings reported. L.T.-S. has received financial support from the NIHR to attend conferences to disseminate the findings from the UK programme.

Funding

This article includes independent research funded by the National Institute for Health Research (NIHR) under its Programme Grants for Applied Research programme (RP-PG-0407-10185). The views expressed in this article are those of the authors and not necessarily those of the NHS, the NIHR or the Department of Health. Financial support for the preparation of this manuscript was also provided by the Dunhill Medical Trust.

Copies of the tools used in this study are available free of charge from the authors. Please visit our website for more details and contact information: http://www.kcl.ac.uk/lsm/research/divisions/cicelysaunders/research/studies/ukroc/tools.aspx.

Ethics approval

The UKROC programme is registered as a multicentre service evaluation and Payment by Results Improvement Project. Collection and reporting of the UKROC dataset is a commissioning requirement according to the NHSE service specification for Level 1 and 2 Rehabilitation Services. According to the UK Health Research Authority, the publication of research findings from de-identified data gathered in the course of routine clinical practice does not require research ethics permission.

Registration

The UKROC programme was registered with the NIHR Comprehensive Local Research Network: ID number 6352.