Using the UKROC dataset to make the case for resources to improve cost-efficiency in neurological rehabilitation

Abstract

Purpose: 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-lifeâ 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. Key messages: (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. Conclusion: (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.

Implications for Rehabilitation

• A key challenge for the provision of rehabilitation services is to strike a cost-effective balance between outcome and service cost, particularly for highly complex cases.

• This article presents a “real-lifeâ application of the UK Rehabilitation Outcomes Collaborative (UKROC) dataset from two tertiary neurological rehabilitation services to demonstrate how the dataset may be used to compare the cost-efficiency of different service models.

• Analysis of routinely collected clinical data can be used to engage commissioners and to make the case for resources to maximize efficiency and improve patient care.

Keywords::

• Cost-efficiency
• costs and cost analysis
• outcome measures
• rehabilitation

Acknowledgements

The authors gratefully acknowledge the hard work of the staff who collected the data presented in this study, and the cooperation of the patients to whom the data relate. Special thanks are due to Bob Dredge for his assistance in developing the costing methodology. Also to Liam Gilligan, Helen Wilkinson, Alan Bill and Marsha Merchant, for their meticulous work in collating the costing data.

Declaration of Interests: The Rehabilitation Complexity Scale and the UK FIM+FAM were both originated through the Regional Rehabilitation Unit at Northwick Park Hospital. This article presents independent research commissioned by the National Institute for Health Research (NIHR) under its Programme Grants for Applied Research funding scheme (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, the Luff Foundation.