Introduction Patients with chronic breathlessness suffer high symptom burden and unmet needs, driving repeated hospitalizations. ICARE program, based on a novel construct of ‘Palliative Rehabilitation,’ integrates early palliative care with post-exacerbation, inpatient rehabilitation for patients with advanced non-malignant lung diseases. This study aims to examine ICARE’s impact on healthcare resource utility, as well as secondary clinical and functional outcomes.
Methods This study compared the number of admissions and total length of stay (TLOS) 6-months pre-enrolment and post-discharge from ICARE. Formal healthcare cost is calculated using daily unit costs provided by Ministry of Health. Functional improvement before-and-after ICARE are measured via 6 minute-walk test (6MWT) and Modified Barthel Index (MBI). Clinical issues are identified and tracked using an assessment template.
Results 88 patients were eligible for analysis. There were significant reductions in acute-hospital TLOS (mean 14.0 days, <0.05) and number of admissions (mean 1.17, <0.05). By projection, reduction in TLOS accrued to an annual 2464 bed-days saved for the tertiary hospital. Net cost deficit was $581 per patient. Subgroup analysis revealed patients with recurrent admissions 6-months prior to ICARE (N=44) generated annual savings of $308,949, while 1-time admitters (N=44) incurred deficit of $410,810. Notably, 1-time admitters had longer LOS in their index tertiary hospital admission and had poorer 6MWT and MBI on enrolment, suggesting more severe exacerbations with greater deconditioning. Functionally, significant improvements in 6MWT (median 30 m, <0.05) and MBI (median 12.5points, <0.05) were observed. 76.5% clinical issues identified were improved/resolved.
Discussion ICARE leads to a cost deficit of $581/patient, equivalent to only an additional half-a-day stay in tertiary hospital. Considering that patients functionally were not fit for discharge at point of enrolment into ICARE, this study demonstrates that ICARE is potentially cost-saving, particularly for recurrent admitters. ICARE also alleviates tertiary hospital bed-occupancy rate while improving clinical and functional outcomes.
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