By: Candice Tang, UHN Trainee and ORT Times Writer
Imagine a hospital with 50 beds, each occupied by a stroke patient undergoing intensive rehabilitation therapy. High-intensity inpatient rehabilitation can last up to six weeks, after which low-intensity outpatient therapy begins outside the hospital. A slow turnaround time for inpatient beds is inevitable, leaving many patients waiting for inpatient care.
One solution is to create an outpatient rehabilitation program that is just as intensive as the inpatient one, which would free up more inpatient beds. This is the principle of Fast Track, an intensive outpatient program for stroke patients at Toronto Rehabilitation Institute (TRI). While the Fast Track program has been running for six years, its cost-effectiveness has not been evaluated. Drs. Stephen Mac and Alan Tam are researchers at the Institute of Health Policy, Management, and Evaluation (IHPME) and TRI. Their research on the cost-effectiveness of the Fast Track program was published in the International Journal of Rehabilitation Research in November.
“While the concept of Fast Track makes perfect clinical sense, to support patients for an early discharge, the system-wide benefits are not as clear,” said Dr. Tam. The team used the incremental cost effectiveness ratio (ICER) to help determine if the number of inpatient bed days saved by the Fast Track program would justify the cost of it. They found that the probability of the program being cost-effective was nearly 100% if decision-makers (e.g, health care payer) were willing to pay $700, equivalent to the cost of an alternate level of care day in acute care awaiting rehabilitation. “Fast Track allows patients to be at home earlier in their recovery process, while still having access to the intensity of rehab services they require for recovery. For the hospital, it allows them to move patients out of an inpatient bed earlier, knowing the patient will be supported and have access to the services they need, and then fill that bed with someone who would otherwise be waiting.” This research suggests that a fast-track outpatient stroke rehabilitation program can help reduce hospital costs, saving money for the provincial government. However, more research is needed to determine how well this program can apply to community hospitals or other rehabilitation centres.
“In the field of rehabilitation, we feel there are more opportunities to apply health technology assessment methodologies, such as cost-effectiveness analyses, to provide high-quality economic evidence to decision-makers when attempting to improve practices and patient care.”
Other authors of the publication include Drs. Wanrudee Isaranuwatchai and Mark Bayley.
Dr. Alan Tam, Postdoctoral Fellow at the Institute of Health Policy, Management and Evaluation (IHPME) and TRI.
Stephen Mac, PhD Candidate at the Institute of Health Policy, Management and Evaluation (IHPME) and TRI.