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

Figures & data

Table I.  Demographics for the two services.

	Unit A (n = 82)	Unit B (n = 91)
Gender: male (%)	56%	59%
Age (years)
Mean (SD)	48 (13)	42 (14)
Range	16–69	17–68
Length of stay (days)
Mean (SD)	147 (106)	98 (66.5)
Range	2–463	3–436
Diagnoses n (%)
Stroke	19 (23.2%)	42 (45.2%)
Other brain injury	34 (41.5%)	34 (36.6%)
Spinal cord injury	2 (2.4%)	5 (5.4%)
Other neurological	17 (20.7%)	12 (12.9%)
Non neurological	10 (12.2%)	–
Episode cost to purchasers
Mean (SD)	£48,101 (£35,231)	£44,316 (£31,416)
Range	£706–£163,439	£9,437–£205,731

Figure 1.  Length of stay compared across different levels of complexity. It shows the breakdown of length of stay for the two units, across five different levels of complexity, based on the total Rehabilitation Complexity Score (RCS) score on admission. The length of stay is consistently higher for Unit A than Unit B at each level.

Figure 2.  Comparison of total FIM+FAM and RCS scores between the two units. It shows “Box and Whiskersâ plots of total RCS and UK FIM+FAM scores for the two units at admission and discharge.

Table II.  Summary of within- and between-unit statistical analysis.

Parameter	Within unit		Between unit
	Admission to discharge (Wilcoxon Sign rank tests)		(Mann–Whitney tests)
	Unit A	Unit B	Admission	Discharge
RCS	z = −7.5	z = −6.1	z = −1.2	z = −7.9
Total score	p < 0.001	p < 0.001	p = 0.217	p < 0.001
UK FIM+FAM	z = −7.4	z = −7.3	z = −1.0	z = −1.2
Total score	p < 0.001	p < 0.001	p = 0.298	p = 0.219

RCS, Rehabilitation Complexity Score; UK FIM+FAM, Functional Assessment Measure (UK version).

Table III.  Breakdown of Rehabilitation Complexity Score (RCS) subscale scores.

RCS subscale	Admission					Discharge
	Unit A	Unit B	Mann–Whitney		Unit A	Unit B	Mann–Whitney
	Median (IQR)	Median (IQR)	z	p	Median (IQR)	Median (IQR)	z	p
Care	2 (1–3)	2 (1–2)	−1.9	0.058	1 (0–2)	1 (0–2)	−0.2	0.847
Nursing	2 (2–3)	2 (2–3)	−0.3	0.744	1 (0–1)	2 (1–3)	−6.2	<0.001
Therapy disciplines	3 (3–3)	2 (2–3)	−5.1	<0.001	2 (1–2)	3 (3–3)	−9.6	<0.001
Therapy intensity	3 (2–3)	2 (2–3)	−1.1	0.276	1 (1–1)	3 (2–3)	−9.8	<0.001
Medical	2 (2–2)	2 (2–2)	−2.9	0.004	0 (0–1)	1 (1–2)	−6.4	<0.001
Total	11 (10–13)	11 (9–13)	−1.2	0.217	5 (3–6)	9 (8–12)	−7.9	<0.001

Table IV.  Comparison of 2008/9 annual service costs for the two units.

	Unit A		Unit B
Unit running costs in 2008/9
Direct clinical costs	£3,499k	87%	£3,343k	83%
Central costs and overheads	£505k	13%	£701k	17%
Total unit costs	£4,004	100%	£4,045	100%
No. of beds (mean occupancy)	30 (27)	90%	22 (21.7)	97%
Activity (OBD)	9855		7921
Mean OBD cost	£406		£507
Mean length of stay	147 days		98 days
Mean cost per case to provider	£59,682		£49,686
Mean cost per case to purchaser (at contract price)	£48,101		£44,316

OBD, occupied bed-day.

Table V.  Staffing levels for the two units.

	Unit A		Unit B
	Occupied bed days = 27		Occupied bed days = 21.7
	WTE	WTE per OBD	WTE	WTE per OBD
Qualified nurses	15.35	0.57	21.15	0.97
Care assistants	23	0.85	11.6	0.53
Nursing and care staff	39.25	1.45	32.75	1.51
Consultants in RM	2	0.07	1.6	0.07
Junior medical staff	2	0.07	2	0.09
Total medical staff	4	0.15	3.6	0.17
Admin and clerical	3	0.11	3	0.14
Managerial etc	2	0.07	1.6	0.07
Total	5	0.19	4.6	0.21
Therapy staff
Physiotherapy	7	0.26	6	0.28
Occupational therapy	4	0.15	6	0.28
Speech and language	1.9	0.07	3.6	0.17
Psychology/counselling	1.6	0.06	2.6	0.12
Dietetics	0.2	0.01	1	0.05
Social work	0	0.00	2	0.09
Technical assistants	1	0.04	2	0.09
Total therapy staff	15.7	0.58	23.2	1.07
Total staffing	59	2.19	60.5	2.78

OBD, occupied bed-day; RM, rehabilitation medicine; WTE, whole time equivalent.

Figure 3.  Breakdown of nursing and therapy staff whole time equivalents (WTEs) by banding. It shows the comparative banding of nursing and therapy staff in WTEs for the two units. Unit A has a higher proportion of nonqualified care staff, and a lower proportion of senior therapy staff than Unit B.