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A trial based economic evaluation of occupational therapy discharge planning for older adults : the HOME randomized trial

WALES K; SALKELD G; CLEMSON L; LANNIN NA; GITLIN L; RUBENSTEIN L; HOWARD K; HOWELL M; CAMERON ID
CLIN REHABIL , 2018, vol. 32, n° 7, p. 919-929
Doc n°: 188284
Localisation : Documentation IRR

D.O.I. : http://dx.doi.org/DOI:10.1177/0269215518764249
Descripteurs : KB1 - TECHNIQUES D'ERGOTHERAPIE, MA - GERONTOLOGIE

OBJECTIVE: To compare the cost effectiveness of two occupational therapy-led
discharge planning interventions from the HOME trial. DESIGN: An economic
evaluation was conducted within the superiority randomized HOME trial to assess
the difference in costs and health-related outcomes associated with the enhanced
program and the in-hospital consultation. Total costs of health and community
service utilization were used to calculate incremental cost-effectiveness ratios,
activities of daily living and quality-adjusted life years. SETTING: Medical and
acute care wards of Australian hospitals ( n=5). SUBJECTS: A total of 400 people
>/= 70 years of age. INTERVENTIONS: Participants were randomized to either (1) an
enhanced program (HOME), involving pre/post discharge visits and two follow-up
phone calls, or (2) an in-hospital consultation using the home and community
environment assessment and the Lawton Instrumental Activities of Daily Living
assessment. MAIN MEASURES: Nottingham Extended Activities of Daily Living (global
measure of activities of daily living) and SF-12V2, transformed into SF-6D
(quality-adjusted life year) measured at baseline and three months post
discharge. RESULTS: The cost of the enhanced program was higher than that of the
in-hospital consultation. However, a higher proportion of patients showed
improvement in activities of daily living in the enhanced program with an
incremental cost-effectiveness ratio of $61,906.00 per person with clinically
meaningful improvement. CONCLUSION: Health services would not save money by
implementing the enhanced program as a routine intervention in medical and acute
care wards. Future research should incorporate longer time horizons and consider
which patient groups would benefit from home visits.

Langue : ANGLAIS

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