The Influence of Activity-Based Funding on Treatment Intensity and Length of Stay of Geriatric Rehabilitation Patients

Abstract

Aim: Little is known about the impact of activity-based funding (ABF) to increase treatment intensity and decrease length of stay (LOS) of inpatient geriatric patients. In January 2014, ABF was implemented in The Netherlands with the aim to increase treatment intensity and shorten LOS in geriatric rehabilitation (GR).

Objectives: To describe the influence of ABF on treatment intensity and LOS of inpatient GR patients before and after ABF was implemented.

Design: Population-based, retrospective cohort study.

Setting: Thirty nursing homes providing inpatient GR across The Netherlands.

Data collection: Digital medical records of patients who had received inpatient GR in Dutch nursing homes across The Netherlands were studied between January 1, 2013 and March 14, 2016. We calculated the mean treatment intensity in hours per week and median LOS in days in 3 cohorts according to the year of admittance. In addition, a historical representative cohort of GR patients who were admitted in 2007 was studied that represented the situation before the ABF reform was announced (eg, funding with a fixed price per day). In 2013, the funding with a fixed price per day was still in use but with compulsory ABF registration. In 2014 and 2015, the ABF was fully implemented. Statistical differences in treatment intensity and LOS were calculated between patients admitted in 2007 and 2013, 2013 and 2014, and 2013 and 2015. Statistical significance was set at a P value of <.02 (Bonferroni correction P = .05/3). Discharge destinations of patients discharged from March 1, 2015 to January 1, 2016 could be obtained and compared with 2007.

Results: The treatment intensity and LOS of 16,823 GR patients could be obtained and compared with the historical cohort from 2007 (n = 2950). Patients who were admitted in the year 2013 received higher treatment intensities and had the same median LOS compared with 2007. After the implementation of ABF in January 2014, the mean treatment intensity increased significantly by 37% (3.8 hours/week in 2013, 4.7 hours/week in 2014, and 5.2 hours/week in 2015). This trend was significant across all rehabilitation diagnoses. After the implementation of ABF, the median LOS decreased significantly by 7 days (46 days in 2013, 42 days in 2014, and 39 days in 2015), which was consistent in all rehabilitation categories except for patients with a total joint replacement or amputation.

Conclusions: Patients who received inpatient GR after introduction of ABF received higher treatment intensities and had a shorter LOS compared with the year before implementation.

Keywords: Activity-based funding; geriatric rehabilitation; healthcare system; incentive; nursing home.