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BACKGROUND/RATIONALE:
This study is a follow-up business case analysis to recently completed VA RR&D project, Processes and Outcomes of Stroke Care in the VHA (03131R), and is being submitted under the Economic Analysis of Implementation Projects RRP solicitation. In our recently completed study, we evaluated the process of care and patient outcomes for two structures of rehabilitation stroke care: (1) VHA acute rehabilitation units and (2) VHA subacute rehabilitation units. We found that process of care, as measured by clinical stroke guideline compliance, was slightly better in two dimensions of care for patients receiving their rehabilitation in acute rehabilitation units. The study also found that the primary patient outcomes in the two settings of care, that is, functional gain during rehabilitation and discharge to the community, were equivalent across the two types of rehabilitation settings. An additional finding of the study identified the length of stay (LOS) in the subacute rehabilitation units to be 7 days longer on average compared to the LOS on acute rehabilitation units (29 vs. 22 days, respectively). This 32% longer LOS has obvious cost implications and raises important economic and policy questions given the recent trends to close acute rehabilitation units or to convert the acute rehabilitation units to subacute rehabilitation units. Over the past 10 years, the number of acute rehabilitation units has decreased from 78 to 44, which is a reduction of 44%. Subacute units have increased from 0 to 18 over the same period.
OBJECTIVE(S):
We propose to answer the following research questions:
1) What are the short-term (0 to 3 months post stroke) and long-term (3-24 months post stroke) VHA costs of care associated with rehabilitation in either acute vs. subacute rehabilitation units?
2) Are costs (short term or long term) associated with clinical stroke guideline compliance? Specifically, does high quality (guideline compliant) care in the near term save money in the future?
3) Are costs (short term or long term) associated with facility characteristics such as staffing, technology, and system organization?
4) Do short-term, long-term, or total costs vary across VISNs?
METHODS:
We will use data collected previously on a cohort of 480 stroke patients who received inpatient rehabilitation care in July 2002 through June 2003 in the VHA. We propose to merge these data with the VHA Decision Support System (DSS) National Data Extracts (NDE) for FY2002-FY2005 to obtain VHA treatment costs for this established cohort of stroke patients for two years following their index stroke admission.
We will conduct both descriptive and multivariate analyses to answer each research question. For the multivariate analyses, we will estimate separate short-term, long-term, and total treatment cost regressions using the natural logarithm of costs as the dependent variable (to deal with skewness). Regressors will include rehabilitation structure (systemic organization, staff expertise, and technological sophistication), degree of clinical stroke guideline compliance, Veterans Integrated Service Network (VISN), and patient sociodemographic characteristics (age, sex, and marital status). A variety of statistical estimators will be used to test the sensitivity of our results.
FINDINGS/RESULTS:
No results to report at this time.
IMPACT:
We anticipate that our results will have major implications for VA policy concerning the efficient and effective provision of rehabilitation services, especially when combined with the recently completed work on quality of care. Together, these results will assist VA policymakers in providing high quality, low cost rehabilitation services to veterans. To achieve its full impact, the results of our work must be communicated clearly to VA rehabilitation policymakers. This communication will occur through a close and continuous working relationship with the VHA Physical Medicine and Rehabilitation (PM&R) Service and the VHA Rehabilitation Strategic Healthcare Group. Specifically, we will seek advice from and present results to the VHA Rehabilitation Strategic Healthcare Group headed by Lucille Beck, Ph.D. A key member of both these groups, Mr. Clifford Marshall, is located at the RORC in Gainesville, and has agreed to serve as our liaison with VA rehabilitation policymakers.
PUBLICATIONS:
None at this time.
DRA:
Health Services and Systems
DRE:
Resource Use and Cost
Keywords:
Cost, Organizational issues, Stroke
MeSH Terms:
none
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