Comparison of inpatient and outpatient rehabilitation regarding health and economic outcomes
Background of the project
Part-time rehabilitation is a medical procedure in which the range of treatments is identical to inpatient rehabilitation, whereas the rehabilitands spend the therapy-free time and the weekends at home. Besides a cost reduction because of the renouncement of the "hotel services" it is expected that with part-time rehabilitation patients can be reached which could not be motivated for inpatient measures.
Research questions and methodology
In the study, the implementation of part-time rehabilitation of orthopedic-rheumatologic patients in four model centres in Rhineland-Palatinate was accompanied scientifically. In a quasi-experimental, parallelised design, the part-time patients from the four model centres were matched with patients from three inpatient centres (about n=450 each group). Data were collected at admission, dismission, as well as six and twelve months after dismission from rehabilitation. Instruments were the IRES patient questionnaire, the questionnaire for rehabiliitation satisfaction from the quality assurance programme of the German Pension Insurance Scheme, a physician questionnaire to document medical parameters, and specific quesitionnaires. The applied treatments were documented. The data on treatment, travelling and other costs were retrieved from the pension insurance records.
Data collection started in December 1997 and was finalised beginning of 2000. The case number that could be attained in inpatient care was far behind the expected size, so that the two samples had to be parallelized using a stratification procedure including age, sex, diagnosis and severity of the symptoms as control variables.
The study showed that the treatment programme in part-time rehabilitation was generally comparable to the inpatient setting, including the differenciation of the offerings and the particularly relevant offers of health education and counseling. Regarding the evaluation of the measures by the rehabilitands, no substantial differences could be found.
The treatment outcomes were the same for the two parallelised samples over the different measurement periods and on the different parameters in the self evaluation of the rehabilitands as well as in the area of social medicine. In the economic evaluation substantial differences were found regarding the costs of nursing. In other areas, including the travelling costs, no significant differences were found.
Duration: 1997 – 1999
Funding: LVA Rheinland-Pfalz (Public pension insurance agency of Rhineland-Palatinate)
Project lead: Bernhard Bührlen at Hochrheininstitut für Rehabilitationsforschung, Bad Säckingen
Bührlen, B. & Jäckel, W. H. (1999). Modellprojekt der LVA Rheinland-Pfalz zur teilstationären Rehabilitation: Erste Ergebnisse. Die Rehabilitation, 38 (Suppl. 1), S61-S67.
Bührlen, B. & Jäckel, W. H. (2002). Teilstationäre orthopädische Rehabilitation: Therapeutische Leistungen, Behandlungsergebnis und Kosten im Vergleich zur stationären Rehabilitation. Die Rehabilitation, 41, 148-159.