Economic evaluation of a nursing-led inpatient unit: the impact of findings on management decisions of service utility and sustainability.
OBJECTIVE
The nursing-led inpatient unit is designed to substitute for a period of care in acute hospital wards and to improve patient outcome prior to discharge to the community. This paper aims to evaluate the cost, from the UK National Health Service perspective, of transfer to a nursing-led inpatient unit for intermediate care and to discuss the impact of these findings to the future development and sustainability of the nursing-led inpatient unit.


BACKGROUND
Recent economic analyses have showed that nursing-led inpatient units are associated with increased costs of care with length of stay as the main driver of inpatient costs.


METHODS
The cost-effectiveness analysis was part of a randomized-controlled trial with a sample size of 175, of which 89 were in the nursing-led inpatient unit arm and 86 in the control arm. Resource use data included length of stay, investigations performed, multiprofessional input and nursing input. Clinical outcome was measured using Barthel Index, a functional status measure.


RESULTS
Cost per day was lower on the nursing-led inpatient unit although cost per hospital stay was higher due to significantly increased length of stay. Postdischarge community care costs were lower. The incremental cost-effectiveness ratio of the treatment was 1044 pounds sterling per point improvement of the Barthel Index.


CONCLUSIONS
The nursing-led inpatient unit was associated with higher costs however, the question of whether the nursing-led inpatient unit is cost-effective has not been clearly answered because of the limited follow-up period of the study. The increased cost of care on the nursing-led inpatient unit was not a major factor in local management decisions about the future of the unit. The changes in the context of service provision within which the nursing-led inpatient unit operated as a result of substantial investment in intermediate care did have a major impact.
Harris
Ruth
R
Nursing Research Unit, King's College London, London, UK.
Richardson
Gerry
G
Griffiths
Peter
P
Hallett
Nancy
N
Wilson-Barnett
Jenifer
J
D000203:Activities of Daily Living; D000368:Aged; D003362:Cost-Benefit Analysis; D005260:Female; D005500:Follow-Up Studies; D017721:Hospital Costs / Q000706:statistics & numerical data; D006757:Hospital Units / Q000191:economics*; D006767:Hospitals, District; D006769:Hospitals, General; D006801:Humans; D007857:Leadership; D007902:Length of Stay / Q000191:economics; D008297:Male; D016294:Models, Nursing; D009722:Nurse Practitioners / Q000191:economics*; D024802:Nurse's Role; D015401:Nursing Administration Research; D015403:Nursing Evaluation Research; D017063:Outcome Assessment, Health Care; D017009:Professional Autonomy; D011383:Progressive Patient Care / Q000191:economics*; D013222:State Medicine / Q000191:economics; D013996:Time and Motion Studies; D006113:United Kingdom