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Impact of a financial incentive on early rehabilitation and outcomes in ICU patients: a retrospective database study in Japan
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Impact of a financial incentive on early rehabilitation and outcomes in ICU patients: a retrospective database study in Japan
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Journal Article
Impact of a financial incentive on early rehabilitation and outcomes in ICU patients: a retrospective database study in Japan
2025
Overview
BackgroundEarly mobilisation of intensive care unit (ICU) patients has been recommended in clinical practice guidelines. Therefore, the Japanese universal health insurance system introduced an additional fee for early mobilisation and/or rehabilitation, which can be claimed by hospitals when starting rehabilitation of ICU patients within 48 hours after their ICU admission. However, the effect of this fee is unknown.ObjectiveTo measure the proportion of ICU patients who received early rehabilitation and the impact on length of ICU stay, the length of hospital stay and discharged to home after the introduction of the financial incentive (additional fee for early mobilisation and/or rehabilitation).Design/methodsWe included patients who were admitted to ICU within 2 days of hospitalisation between April 2016 and January 2020. We conducted interrupted time series analyses to assess the effects of the introduction of the financial incentive.ResultsThe proportion of patients who received early rehabilitation immediately increased after the introduction of the financial incentive (rate ratio (RR) 1.293, 95% CI 1.240 to 1.349). The RR for proportion of patients received early rehabilitation was 1.008 (95% CI 1.005 to 1.011) in the period after the introduction of the financial incentive compared with period before its introduction. There was no statistically significant change in the mean length of ICU stay, the mean length of hospital stay and the proportion of patients who were discharged to home.ConclusionAfter the introduction of the financial incentive, the proportion of ICU patients who received early rehabilitation increased. However, the effects of the financial incentive on the length of ICU stay, the length of hospital stay and the proportion of patients who were discharged to home were limited.
Publisher
BMJ Publishing Group Ltd,BMJ Publishing Group LTD
Subject
/ Aged
/ Clinical practice guidelines
/ Early Ambulation - economics
/ Early Ambulation - statistics & numerical data
/ Female
/ Humans
/ Intensive Care Units - economics
/ Intensive Care Units - statistics & numerical data
/ Interrupted Time Series Analysis
/ Japan
/ Length of Stay - statistics & numerical data
/ Male
/ Patient Discharge - statistics & numerical data
/ Patients
