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Cost-efficiency of specialist inpatient rehabilitation for working-aged adults with complex neurological disabilities: a multicentre cohort analysis of a national clinical data set
ObjectivesTo evaluate functional outcomes, care needs and cost-efficiency of specialist rehabilitation for a multicentre cohort of inpatients with complex neurological disability, comparing different diagnostic groups across 3 levels of dependency.DesignA multicentre cohort analysis of prospectively collected clinical data from the UK Rehabilitation Outcomes Collaborative (UKROC) national clinical database, 2010–2015.SettingAll 62 specialist (levels 1 and 2) rehabilitation services in England.ParticipantsWorking-aged adults (16–65 years) with complex neurological disability. Inclusion criteria: all episodes with length of stay (LOS) 8–400 days and complete outcome measures recorded on admission and discharge. Total N=5739: acquired brain injury n=4182 (73%); spinal cord injury n=506 (9%); peripheral neurological conditions n=282 (5%); progressive conditions n=769 (13%).InterventionSpecialist inpatient multidisciplinary rehabilitation.Outcome measuresDependency and care costs: Northwick Park Dependency Scale/Care Needs Assessment (NPDS/NPCNA). Functional independence: UK Functional Assessment Measure (UK Functional Independence Measure (FIM)+FAM). Cost-efficiency: (1) time taken to offset rehabilitation costs by savings in NPCNA-estimated costs of ongoing care, (2) FIM efficiency (FIM gain/LOS days), (3) FIM+FAM efficiency (FIM+FAM gain/LOS days). Patients were analysed in 3 groups of dependency.ResultsMean LOS 90.1 (SD 66) days. All groups showed significant reduction in dependency between admission and discharge on all measures (paired t tests: p<0.001). Mean reduction in ‘weekly care costs’ was greatest in the high-dependency group at £760/week (95% CI 726 to 794)), compared with the medium-dependency (£408/week (95% CI 370 to 445)), and low-dependency (£130/week (95% CI 82 to 178)), groups. Despite longer LOS, time taken to offset the cost of rehabilitation was 14.2 (95% CI 9.9 to 18.8) months in the high-dependency group, compared with 22.3 (95% CI 16.9 to 29.2) months (medium dependency), and 27.7 (95% CI 15.9 to 39.7) months (low dependency). FIM efficiency appeared greatest in medium-dependency patients (0.54), compared with the low-dependency (0.37) and high-dependency (0.38) groups. Broadly similar patterns were seen across all 4 diagnostic groups.ConclusionsSpecialist rehabilitation can be highly cost-efficient for all neurological conditions, producing substantial savings in ongoing care costs, especially in high-dependency patients.
Journal Article
Cost-efficiency of specialist hyperacute in-patient rehabilitation services for medically unstable patients with complex rehabilitation needs: a prospective cohort analysis
ObjectivesTo evaluate functional outcomes, care needs and cost-efficiency of hyperacute (HA) rehabilitation for a cohort of in-patients with complex neurological disability and unstable medical/surgical conditions.DesignA multicentre cohort analysis of prospectively collected clinical data from the UK Rehabilitation Outcomes Collaborative (UKROC) national clinical database, 2012–2015.SettingTwo HA specialist rehabilitation services in England, providing different service models for HA rehabilitation.ParticipantsAll patients admitted to each of the units with an admission rehabilitation complexity M score of ≥3 (N=190; mean age 46 (SD16) years; males:females 63:37%). Diagnoses were acquired brain injury (n=166; 87%), spinal cord injury (n=9; 5%), peripheral neurological conditions (n=9; 5%) and other (n=6; 3%).InterventionSpecialist in-patient multidisciplinary rehabilitation combined with management and stabilisation of intercurrent medical and surgical problems.Outcome measuresRehabilitation complexity and medical acuity: Rehabilitation Complexity Scale—version 13. Dependency and care costs: Northwick Park Dependency Scale/Care Needs Assessment (NPDS/NPCNA). Functional independence: UK Functional Assessment Measure (UK FIM+FAM). Primary outcomes: (1) reduction in dependency and (2) cost-efficiency, measured as the time taken to offset rehabilitation costs by savings in NPCNA-estimated costs of on-going care in the community.ResultsThe mean length of stay was 103 (SD66) days. Some differences were observed between the two units, which were in keeping with the different service models. However, both units showed a significant reduction in dependency and acuity between admission and discharge on all measures (Wilcoxon: p<0.001). For the 180 (95%) patients with complete NPCNA data, the mean episode cost was £77 119 (bootstrapped 95% CI £70 614 to £83 894) and the mean reduction in ‘weekly care costs’ was £462/week (95% CI 349 to 582). The mean time to offset the cost of rehabilitation was 27.6 months (95% CI 13.2 to 43.8).ConclusionsDespite its relatively high initial cost, specialist HA rehabilitation can be highly cost-efficient, producing substantial savings in on-going care costs, and relieving pressure in the acute care services.
Journal Article
تريليون دولار : بيل كامبل : مدرب نخبة قادة \سيليكون فالي\ إلى النجاح
هذا الكتاب عن مسيرة مدرب تعادل قيمته \"تريليون دولار\" هو بيل كامبل مدرب نخبة قادة \"سيليكون فالي\" إلى النجاح ولقد ساعد بيل كامبل في بناء بعض أكبر الشركات في سيليكون فالي من أمثال أبل وغوغل وإنتويت حتى أن جهوده أسهمت في قيام شركات تبلغ قيمتها السوقية تريليون دولار ولقد أرشد بيل كامبل لاعب كرة القدم والمدرب لفرق الجامعات قادة رؤيويين من أمثال ستيف جوبز ولاري بيج وإريك شميدت ودرب العشرات من القادة في طول الولايات المتحدة وعرضها.
BOOK
A cost analysis of specialist inpatient neurorehabilitation services in the UK
Objective: To determine the range and variation in costs and service characteristics between different levels of specialist neurorehabilitation services in England, and to determine key predictors of service costs.
Design: A retrospective analysis of service costs, staffing and activity levels, with comparison across service types.
Setting: Specialist neurorehabilitation services (n = 17) from different areas of England, were divided into three types according to predefined criteria: adult level 1 (tertiary) (n = 8) and level 2a (supra-district) (n = 7) services; and children’s services (n = 2).
Main measures: Annual service costs were collated using a standard costing template, and divided according to principal cost type (direct/indirect/overheads) and behaviour (variable/non-variable). For comparison between the level 1 and 2a services, costs and service characteristics were calculated per occupied bed.
Results: The percentage breakdown of costs was consistent across all three service types, with direct costs making up 83%, indirect 10%, and overheads 7% of total costs. The median variable component ranged from 75 to 76%. Staff pay made up 66% and accounted for 95% of the variance of the total costs in adult services. Level 1 services had higher total staffing costs, mainly reflecting higher therapy staff numbers (z = –2.0, P = 0.05). The median total costs/bed-day were: level 1 £530 (interquartile range (IQR) 435–574) (equivalent to US$860 or €650) and level 2a £402 (US$650 or €459) (IQR 326–451) (z = –2.5, P = 0.009). Children’s services cost almost twice that (£1017–1177).
Conclusions: Expected variations in cost are largely due to differences in staff costs. Total staff costs projected by 150% provided a reasonable estimate of total unit costs.
Journal Article
Moon Knight. Final rest
\"The run of Doug Moench and Bill Sienkiewicz comes to a close as the moon sets on Marc Spector. But first he must survive threats old and new - including the deadly return of Stained Glass Scarlet! The murderous Black Spectre has a killer plan to pin his crimes on Moon Knight, and a rematch looms against the savage Werewolf by Night - but will the Fly prove to be far more than an annoyance for Moon Knight? Then, when Marlene finds herself at the mercy of magic, Marc Spector seeks out a professional: Doctor Strange! And secrets from the past are uncovered as Zohar, the master of divine illumination, strikes. The dead shall rise - but will Moon Knight meet his final rest?\"--Page 4 of cover.
Book
Curriculum 21
What year are you preparing your students for? 1973? 1995? Can you honestly say that your school's curriculum and the program you use are preparing your students for 2015 or 2020? Are you even preparing them for today?\"\"With those provocative questions, author and educator Heidi Hayes Jacobs launches a powerful case for overhauling, updating, and injecting life into the K-12 curriculum. Sharing her expertise as a world-renowned curriculum designer and calling upon the collective wisdom of 10 education thought leaders, Jacobs provides insight and inspiration in the following key areas:Content and assessment: How to identify what to keep, what to cut, and what to create, and where portfolios and other new kinds of assessment fit into the picture.Program structures: How to improve our use of time and space and groupings of students and staff.Technology: How it's transforming teaching, and how to take advantage of students' natural facility with technology.Media literacy: The essential issues to address, and the best resources for helping students become informed users of multiple forms of media.Globalization: What steps to take to help students gain a global perspective.Sustainability: How to instill enduring values and beliefs that will lead to healthier local, national, and global communities.Habits of mind: The thinking habits that students, teachers, and administrators need to develop and practice to succeed in school, work, and life.The answers to these questions and many more make Curriculum 21 the ideal guide for transforming our schools into what they must become: learning organizations that match the times in which we live.
eBook
Measuring and Sustaining the New Economy
Sustaining the New Economy will require public policies that remain relevant to the rapid technological changes that characterize it. While data and its timely analysis are key to effective policy-making, we do not yet have adequate statistical images capturing changes in productivity and growth brought about by the information technology revolution. This report on a STEP workshop highlights the need for more information and the challenges faced in measuring the New Economy and sustaining its growth.
eBook