Factors and Trade-Offs With Rehabilitation Effectiveness and Efficiency in Newly Disabled Older Persons

Objective: To determine the factors for rehabilitation effectiveness (REs) and rehabilitation efficiency (REy) among newly disabled older persons and if there is any trade-off between REs and REy. Design: Retrospective cohort study. Setting: Rehabilitation hospitals. Participants: Patients (N=8828) aged >= 65 years admitted for inpatient rehabilitation from 1996 to 2005. Interventions: Not applicable. Main Outcome Measures: Independent factors affecting REs and REy were determined. The median rank ratios of REs to REy for each admission Barthel Index (BI) unit and number of days of stay were generated. The ideal ranges of admission BI score and length of stay (LOS) that corresponded to the REs to REy median rank ratio of 1 (both REs and REy optimized) were identified. Results: Factors associated with poorer REs and REy were older age, Malay ethnicity, delayed admission, admission diagnosis of amputation, and comorbidities of dementia and stroke. An increase of 10 in admission BI score was associated with an increase of 3.47% in REs but a decrease of 1.1 per 30 days in REy; and an increase in LOS of 2.7 days was associated with an increase of 28% in REs but a decrease of 5.2 per 30 days in REy. A trade-off relation between REs and REy with respect to admission functional status and LOS was observed. The range, which optimized both REs and REy, was 50 to 59 units for admission BI score and 37 to 46 days for LOS. Conclusions: There are trade-offs between REs and REy with respect to admission functional status and LOS. Clinicians, policymakers, patients, and other stakeholders should be aware of such trade-offs when they make joint policy decisions about rehabilitation services. (C) 2014 by the American Congress of Rehabilitation Medicine