Rapid Health Technology Assessment in Rehabilitation Hospital: Review Article

Document Type : Review Article

Authors

1 Department of Health Technology Assessment (HTA), Deputy of Curative Affairs, Ministry of Health and Medical Education, Tehran, Iran

2 PhD Candidate, Department of Health Service Management, School of Management and Economics, Islamic Azad University Science and Research Branch AND Technical Officer, Department of Health Technology Assessment (HTA), Deputy of Curative Affairs, Ministry of Health and Medical Education, Tehran, Iran

3 Assistant Professor, National Institute for Health Research AND Health Technology, Standardization and Tariff Office, Deputy of Curative Affairs, Ministry of Health and Medical Education, Tehran, Iran

Abstract

Background: Medical advances, improved health status, and increased longevity have led to increased elderly in the society; therefore, the role of rehabilitation centers in the service industry has grown considerably in the two past decades.Methods: The studies compared types of rehabilitation centers for the treatment of patients with motor or perception disability and other methods commonly used in rehabilitation, in terms of functional outcomes, Barthel index, and cost-effectiveness, were evaluated. The Cochrane, CRD (Centre for Reviews and Dissemination), Scopus, and Google scholar databases were searched until June 2012. Results were analyzed using qualitative method.Findings: According to 15 included articles, the Barthel index scores in patients with an inpatient rehabilitation (42 ± 29 points) were more than outpatient rehabilitation (26 ± 23 points) (P < 0.050). For inpatient centers, early rehabilitation led to the rapid acquisition of functional abilities than outpatient centers (1.55 vs. 0.50). Regarding to cost-effectiveness of heart diseases, the adjusted cost difference between outpatient and inpatient rehabilitation was about -2895 Euro (P = 0.102); adjusted effect difference was about 0.018 QALY (Quality-adjusted life year) in favor of outpatients rehabilitation, too.Conclusion: With regard to the potential of rehabilitation services and outpatient clinics in day clinics, the establishment of rehabilitation centers was not cost-effective. So, it is proposed to provide services to disabled patients in “rehabilitation units” established in specialized hospitals.

Keywords


  1. WHO Expert Committee on Disability Prevention and Rehabilitation. Disability prevention and rehabilitation. World Health Organ Tech Rep Ser 1981; 668: 1-39.
  2. Vieira ER, Freund-Heritage R, da Costa BR. Risk factors for geriatric patient falls in rehabilitation hospital settings: a systematic review. Clin Rehabil 2011; 25(9): 788-99.
  3. Ahangari M, Kamali M, Arjmand Hesabi M. The effects of hypertension on quality of elderly people aged member of the cultural center in Tehran. Salmand Iran J Ageing 2008; 3(7): 26-32. [In Persian].
  4. Mahler MP, Zuger K, Kaspar K, Haefeli A, Jenni W, Leniger T, et al. A cost analysis of the first year after stroke - early triage and inpatient rehabilitation may reduce long term costs. Swiss Med Wkly 2008; 138(31-32): 459-65.
  5. Muir SW, Yohannes AM. The impact of cognitive impairment on rehabilitation outcomes in elderly patients admitted with a femoral neck fracture: a systematic review. J Geriatr Phys Ther 2009; 32(1): 24-32.
  6. Lindsay MP, Gubitz G, Bayley M, Hill MD, Davies-Schinkel C, Singh S, et al. Canadian best practice recommendations for stroke care (Update 2010). On behalf of the Canadian Stroke Strategy Best Practices and Standards Writing Group. Ottawa, ON: Canadian Stroke Network; 2010.
  7. Mohamadi F, Taherian A, Hosseini MA, Rahgozar M. Effect of home-based cardiac rehabilitation in home on quality of life in the patients with myocardial infarction. J Rehab 2006; 7(3): 11-9. [In Persian].
  8. Vincent HK, Vincent KR. Functional and economic outcomes of cardiopulmonary patients: a preliminary comparison of the inpatient rehabilitation and skilled nursing facility environments. Am J Phys Med Rehabil 2008; 87(5): 371-80.
  9. Bachmann S, Finger C, Huss A, Egger M, Stuck AE, Clough-Gorr KM. Inpatient rehabilitation specifically designed for geriatric patients: systematic review and meta-analysis of randomised controlled trials. BMJ 2010; 340: c1718.
  10. Kramer AM, Steiner JF, Schlenker RE, Eilertsen TB, Hrincevich CA, Tropea DA, et al. Outcomes and costs after hip fracture and stroke. A comparison of rehabilitation settings. JAMA 1997; 277(5): 396-404.
  11. Loder E, Witkower A, McAlary P, Huhta M, Matarrazzo J. Rehabilitation hospital staff knowledge and attitudes regarding pain. Am J Phys Med Rehabil 2003; 82(1): 65-8.
  12. Parker SG, Oliver P, Pennington M, Bond J, Jagger C, Enderby PM, et al. Rehabilitation of older patients: day hospital compared with rehabilitation at home. A randomised controlled trial. Health Technol Assess 2009; 13(39): 1-iv.
  13. Schweikert B, Hahmann H, Steinacker JM, Imhof A, Muche R, Koenig W, et al. Intervention study shows outpatient cardiac rehabilitation to be economically at least as attractive as inpatient rehabilitation. Clin Res Cardiol 2009; 98(12): 787-95.
  14. Zeidler J, Mittendorf T, Vahldiek G, Zeidler H, Merkesdal S. Comparative cost analysis of outpatient and inpatient rehabilitation for musculoskeletal diseases in Germany. Rheumatology (Oxford) 2008; 47(10): 1527-34.
  15. Harrison JP, Kirkpatrick N. The improving efficiency frontier of inpatient rehabilitation hospitals. Health Care Manag (Frederick ) 2011; 30(4): 313-21.
  16. Thompson JM, McCue MJ. Performance of freestanding inpatient rehabilitation hospitals before and after the rehabilitation prospective payment system. Health Care Manage Rev 2010; 35(1): 36-45.
  17. Khiaocharoen O, Pannarunothai S, Riewpaiboon W, Ingsrisawang L, Teerawattananon Y. Economic evaluation of rehabilitation services for inpatients with stroke in Thailand: a prospective cohort study. Value in Health Regional Issues 2012; 1(1): 29-35.
  18. Sood N, Buntin MB, Escarce JJ. Does how much and how you pay matter? evidence from the inpatient rehabilitation facility prospective payment system. J Health Econ 2006; 27(4): 1046-59.
  19. Khan F, Ng L, Gonzalez S, Hale T, Turner-Stokes L. Multidisciplinary rehabilitation programmes following joint replacement at the hip and knee in chronic arthropathy. Cochrane Database Syst Rev 2008; (2): CD004957.
  20. Handoll HH, Cameron ID, Mak JC, Finnegan TP. Multidisciplinary rehabilitation for older people with hip fractures. Cochrane Database Syst Rev 2009; (4): CD007125.
  21. Stone SP, Ali B, Auberleek I, Thompsell A, Young A. The Barthel index in clinical practice: use on a rehabilitation ward for elderly people. J R Coll Physicians Lond 1994; 28(5): 419-23.
  22. Shah S, Vanclay F, Cooper B. Improving the sensitivity of the Barthel Index for stroke rehabilitation. J Clin Epidemiol 1989; 42(8): 703-9.
  23. Olsen TS. Arm and leg paresis as outcome predictors in stroke rehabilitation. Stroke 1990; 21(2): 247-51.
  24. Cameron ID, Lyle DM, Quine S. Cost effectiveness of accelerated rehabilitation after proximal femoral fracture. J Clin Epidemiol 1994; 47(11): 1307-13.