Economic Effects of Occupational Therapy Services for Adults in Acute and Subacute Care Settings: A Systematic Review

Importance: Research supports the clinical effectiveness of hospital-based occupational therapy to improve functional outcomes, but no synthesis of economic evaluations of occupational therapy services provided in these settings has been published. Objective: To determine the economic value of occupational therapy services in acute and subacute care settings. Data Sources: MEDLINE, CINAHL, CENTRAL, EconLit, Embase, National Health Services Economic Evaluation Database, PsycINFO, ProQuest (Health and Medicine and Social Science subsets only), OTseeker, and gray literature. Study Selection and Data Collection: Eligible studies used trial-based or modeled economic analyses and included an adult population (ages ≥18 yr) and occupational therapy assessments or interventions provided in acute and subacute care. Two authors independently assessed abstracts and then full text. Articles were then appraised using the Evers Consensus on Health Economic Criteria. Findings: The authors identified 13,176 unique abstracts and assessed 190 full-text articles for eligibility. Ten studies were included in the systematic review; they varied in their primary objectives, methodology, costs, and outcomes. Studies examined the cost–benefit, cost-effectiveness, cost–utility, or cost minimization of a range of occupational therapy services. Five studies suggested that occupational therapy services offer value for money (lower cost, higher benefit); 4 suggested that they offer higher cost and benefits. One study that investigated upper limb rehabilitation did not indicate value for money. Conclusions and Relevance: The findings suggest that occupational therapy for adults poststroke and post–traumatic brain injury, acute discharge planning, and pre– and post–hip replacement is cost-effective, but further research is needed to substantiate these findings. What This Article Adds: The findings provide preliminary evidence of the economic effectiveness of occupational therapy in acute and subacute care.

Are Subacute Care Patients Living Longer?

In order to provide prognostic information for gerontologists who regularly counsel families, we determined to measure the longevity of subacute patients who have feeding tubes and tracheostomies. This study compares two cohorts of patients: 2002-2006 and 2015-2019. T-tests were performed to compare the total days in acute care, the total survival days, and the number of hospital admissions between the two groups. Results revealed (2002-2006, 2015-2019), some variance in the acute care days between the two groups (M= 15.4186, 21.49438) and p= .66. There is a wide difference in the total survival days between the two groups with individuals from 2015-2019 living longer than 2002-2006 (M= 229.8198, 644.0449), p< .001. However, there is no statistically significant difference in the number of hospital admissions between the two groups (M= 0.994186, 0.7752809), p= .09754. We hypothesize that advances in technology, medicine, and care over the span of 17 years contribute to increased longevity. On average, patients in the 2015-2019 group survived 414 days longer than the first group. Yet, even with such advances, more days were spent in acute care in the second group (2015-2019). Our data show subacute longevity has nearly tripled in the last decade. Although patients are living longer, they are often in a vegetative state; in most instances, there is no apparent improvement in quality of life. This study provides current data which will help gerontologists improve prognostication and allow them to form a more realistic long view of care.

Frailty predicts failure to discharge patients home from a subacute-care unit: a 3-year Italian experience

Background The primary purpose of Subacute Care Units (SCU) is to decongest acute hospital wards and facilitate the return of older patients to home. Aims We analyzed the clinical characteristics and outcomes of patients admitted to an Italian SCU, and we explored factors associated with discharge to locations other than home (outcome). Methods This retrospective observational cohort study was conducted at a medium-sized suburban hospital, enrolling all patients consecutively admitted to one SCU from October 2017 to February 2020. We collected demographics, cause of admission, comorbidities, cognition, Barthel Index (BI), nutritional status, Clinical Frailty Scale (CFS), length of stay, and discharge destination. Delirium was screened with the 4AT score. We adopted a multivariable conditional logistic regression model to identify the factors associated with the outcome. Results Frail subjects accounted for 58.6% of 406 patients (mean age 78.2 years, SD 11.6), while 61% were classified as functionally dependent. More than half of patients had relevant comorbidity, approximately 80% had a poor nutritional status, and 25% had pre-existing dementia. The overall prevalence of delirium was 14.5%. Most patients came from a hospital setting; recurrent reasons for admission were infections (70.5%) and heart failure (12.7%). Having a urinary bladder catheter at discharge, being overtly frail (CFS > 8), and low BI score were factors independently associated with not being discharged home. Discussion and conclusion The routine assessment of frailty, as expressed by the CFS, may help redirecting the patients eligible for SCU admission.

Effectiveness of an infection prevention strategy to limit exposure of high-risk patients to COVID-19 in a hospital-based subacute unit: a descriptive report

The coronavirus (COVID-19) epidemic has put unprecedented stress on hospitals as well as skilled nursing facilities, where reside some of the most vulnerable individuals at high risk of mortality and complications of this infection. This report highlights the strategy and success of hospital infection prevention efforts to protect the residents of an in-hospital subacute unit with 24 at-risk patients with chronic pulmonary disease in northern California. Specific efforts are detailed, with results of surveillance testing reported, including both viral PCR and serological IgG assays. Implications for other long-term subacute care facilities are discussed, as well as advantages and specific challenges for ‘distinct part’ versus ‘free-standing’ subacute care units.

Characteristics and outcomes of patients receiving Hospital at Home Services in the South West of Sydney

Background Hospital at home (HaH) provides acute or subacute care in a patient’s home, that normally would require a hospital stay. HaH has consistently been shown to improve patient outcomes and reduce health care costs. The characteristics and outcomes of patients receiving HaH care across the South Western Sydney Local Health District (SWSLHD) has not been well described. This project aimed to describe the characteristics and outcomes of HaH services across the SWSLHD. Methods The characteristics of patients referred to HaH between January 2017 and December 2019, the indications for HaH, and representation rates to hospital emergency department (ED) will be presented. Results Between January 2017 and December 2019 there was 7118 referrals to the local health district’s (LHD) HaH services, among 6083 patients (3094 females, 51%), median age 56 years (Interquartile range (IQR), 40–69). The majority of indications for HaH were for intravenous venous (IV) medications (78%, n = 5552), followed by post-operative drain management (11%, n = 789), rehab in the home (RiTH) (5%, n = 334), bridging anticoagulant therapy (4%, n = 261), and intraperitoneal medications (1%, n = 100). The requirement for presentation to an ED for care, while receiving HaH only occurred on 172 (2%) of occasions. The average length of HaH treatment was 7-days (IQR 4–16). Rates of presentation to ED for HaH patients have decreased since 2017, 3.4% (95% CI 2.7–4.2%), 2018 2.1% (95% CI 1.5–2.8%), and 2019 1.8% (95% CI 1.3–2.4%), p-value for trend < 0.001. Conclusion Hospital at Home is well established, diverse, and safe clinical service to shorten, or avoid hospitalisation, for many patients. Importantly, avoidance of hospitalisation can avoid many risks that are associated with being cared for in the hospital setting.