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Physikalische Medizin, Rehabilitationsmedizin, Kurortmedizin 2020; 30(03): 160-167
DOI: 10.1055/a-1015-0687
Original Article

Healthcare Costs for Older Patients Before and After Inpatient Rehabilitation: A Retrospective and Prospective Longitudinal Cohort Study

Kosten nach einer stationären geriatrischen Rehabilitation
Stefan Bachmann
1   Department of Rheumatology/Rehabilitation, Kliniken Valens, Valens, Switzerland
2   Department of Geriatrics, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
,
Nubio Pfaundler
2   Department of Geriatrics, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
,
Peter Oesch
3   Department of Therapies, Kliniken Valens, Valens, Switzerland
,
Jan Pieter Kool
4   Research Department, Rehabilitation Center Kliniken Valens, Valens, Switzerland
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Abstract

Background Little is known about the costs incurred over the 12 months before and after inpatient geriatric rehabilitation in Switzerland.

Objectives To compare direct healthcare costs for elderly patients over a period of 12 months before and after inpatient rehabilitation and to determine predictive factors for costs after discharge.

Design Retrospective and prospective cohort study.

Patients and Methods Elderly patients referred for inpatient rehabilitation to the rehabilitation centre Walenstadtberg of Kliniken Valens, Switzerland, were included. Cost data were collected from healthcare insurance providers. Comparisons of costs before and after discharge from rehabilitation were performed. The effect of patient characteristics (Multimorbidity, Health-related quality of life, Age, Vulnerability, Independence in activities of daily living, Sex, and Mobility) on costs 12 months before and after rehabilitation was evaluated with regression analysis.

Results A total of 210 patients were enrolled, and 136 completed the clinical follow-up. Seventy-five patients were included in the cost analysis. Total mean healthcare costs per person in the 12-month period before discharge were CHF 24 429, compared with CHF 18 154 in the 12-month period after discharge. After rehabilitation lower costs were reported for hospital admissions, while costs for drugs and therapy were significantly higher. Multimorbidity and health-related quality of life were predictors of costs before rehabilitation (adjusted R-square 0.183). Higher costs after rehabilitation were predicted by higher multimorbidity (adjusted R-square 0.09), lower independence in activities of daily living (adjusted R-square 0.04) and lower health-related quality of life (adjusted R-square 0.03).

Conclusion The mean total costs before geriatric rehabilitation were significantly higher compared with the mean costs after discharge from geriatric rehabilitation. In particular, the mean costs for hospitalizations were lower after rehabilitation. Multimorbidity and lower health-related quality of life predicted higher costs before and after rehabilitation.

Zusammenfassung

Hintergrund In der Schweiz existieren keine Kostendaten zur stationären geriatrischen Rehabilitation für einen Zeitraum von 12 Monaten vor und nach Rehabilitation.

Ziele Vergleich der direkten Krankheitskosten bei geriatrischen Patienten 12 Monate vor und nach einer stationären geriatrischen Rehabilitation. Suche nach prädiktiven Faktoren bezüglich der Kosten nach der Rehabilitation.

Design Retro- und prospektive Kohortenstudie

Material und Methoden Ältere Patienten zugewiesen zur geriatrischen Rehabilitation ins Rehabilitationszentrum Walenstadtberg der Kliniken Valens wurden eingeschlossen. Die Krankheitskosten wurden via Daten der Krankenkassen erfasst. Kostenanalysen bezüglich der Kosten vor und nach Rehabilitation wurden durchgeführt. Der Einfluss von Patienten- bezogenen Faktoren (Multimorbidität, Lebensqualität, Alter, Verletzlichkeit, Aktivitäten des täglichen Lebens, Geschlecht und Mobilität) wurden mittels Regressionsanalysen untersucht.

Ergebnisse 210 Patienten wurden eingeschlossen. Von 136 lagen nach Abschluss des Follow-up vollständige klinische Daten vor. 75 Patienten konnten in die Kostenanalyse eingeschlossen werden. Die mittleren totalen Kosten in den 12 Monaten vor Rehabilitation betrugen CHF 24’429, verglichen mit CHF 18’154 in den 12 Monaten nach Klinikaustritt. Die Hospitalisationskosten nach Austritt waren signifikant tiefer, während dem die Kosten für Medikamente und Therapien nach Austritt höher waren. Multimorbidität und tiefere Lebensqualität waren prädiktiv für höhere Kosten vor der Rehabilitation (adjustiertes R Quadrat 0.183). Höhere Kosten nach der Rehabilitation korrelierten mit der Multimorbidität (adjustiertes R Quadrat 0.09), tieferen ADL-Scores (adjustiertes R Quadrat 0.04) und tieferer Lebensqualität (adjustiertes R Quadrat 0.03).

Diskussion Die mittleren totalen Kosten vor der stationären Rehabilitation waren signifikant höher als die mittleren totalen Kosten nach der Rehabilitation. Vor allem die durchschnittlichen Hospitalisationskosten waren nach der Rehabilitation tiefer. Multimorbidität und tiefere Lebensqualität waren prädiktiv für höhere Kosten vor und nach der Rehabilitation.

Key words

Costs - Elderly - Rehabilitation - Economics - Hospitalization

Schlüsselwörter

Kosten - Ältere Patienten - Rehabilitation - Oekonomie - Hospitalisation


Publication History

Received: 15 June 2019

Accepted: 16 September 2019

Article published online:
22 October 2019

© Georg Thieme Verlag KG
Stuttgart · New York

 

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