title: Factors and trade-offs with rehabilitation effectiveness and efficiency in newly disabled older persons.
abstract: OBJECTIVE
  To determine the factors for rehabilitation effectiveness (REs) and rehabilitation efficiency (REy) among newly disabled older persons and if there is any trade-off between REs and REy.
  
  
  METHODS
  Retrospective cohort study.
  
  
  METHODS
  Rehabilitation hospitals.
  
  
  METHODS
  Patients (N=8828) aged ≥65 years admitted for inpatient rehabilitation from 1996 to 2005.
  
  
  METHODS
  Not applicable.
  
  
  METHODS
  Independent factors affecting REs and REy were determined. The median rank ratios of REs to REy for each admission Barthel Index (BI) unit and number of days of stay were generated. The ideal ranges of admission BI score and length of stay (LOS) that corresponded to the REs to REy median rank ratio of 1 (both REs and REy optimized) were identified.
  
  
  RESULTS
  Factors associated with poorer REs and REy were older age, Malay ethnicity, delayed admission, admission diagnosis of amputation, and comorbidities of dementia and stroke. An increase of 10 in admission BI score was associated with an increase of 3.47% in REs but a decrease of 1.1 per 30 days in REy; and an increase in LOS of 2.7 days was associated with an increase of 28% in REs but a decrease of 5.2 per 30 days in REy. A trade-off relation between REs and REy with respect to admission functional status and LOS was observed. The range, which optimized both REs and REy, was 50 to 59 units for admission BI score and 37 to 46 days for LOS.
  
  
  CONCLUSIONS
  There are trade-offs between REs and REy with respect to admission functional status and LOS. Clinicians, policymakers, patients, and other stakeholders should be aware of such trade-offs when they make joint policy decisions about rehabilitation services.
authors.affiliation: Agency for Integrated Care, Singapore.
authors.forename: Patsy
authors.initials: P
authors.lastname: Chow
authors.affiliation: Saw Swee Hock School of Public Health, National University of Singapore, National University Health System, Singapore.
authors.forename: Cynthia
authors.initials: C
authors.lastname: Chen
authors.affiliation: Saw Swee Hock School of Public Health, National University of Singapore, National University Health System, Singapore.
authors.forename: Angela
authors.initials: A
authors.lastname: Cheong
authors.affiliation: Saw Swee Hock School of Public Health, National University of Singapore, National University Health System, Singapore.
authors.forename: Ngan Phoon
authors.initials: NP
authors.lastname: Fong
authors.affiliation: Ang Mo Kio Thye Hua Kwan Hospital, Singapore.
authors.forename: Kin Ming
authors.initials: KM
authors.lastname: Chan
authors.affiliation: St Luke's Hospital, Singapore.
authors.forename: Boon Yeow
authors.initials: BY
authors.lastname: Tan
authors.affiliation: St Andrew's Community Hospital, Singapore.
authors.forename: Edward
authors.initials: E
authors.lastname: Menon
authors.affiliation: Bright Vision Hospital, Singapore.
authors.forename: Chye Hua
authors.initials: CH
authors.lastname: Ee
authors.affiliation: Khoo Teck Puat Hospital, Singapore.
authors.forename: Kok Keng
authors.initials: KK
authors.lastname: Lee
authors.affiliation: Saw Swee Hock School of Public Health, National University of Singapore, National University Health System, Singapore; Institute of Health Sciences, University Brunei Darussalam, Brunei.
authors.forename: David
authors.initials: D
authors.lastname: Koh
authors.affiliation: Saw Swee Hock School of Public Health, National University of Singapore, National University Health System, Singapore. Electronic address: Gerald_Koh@nuhs.edu.sg.
authors.forename: Gerald C
authors.initials: GC
authors.lastname: Koh
mesh_terms: D000203:Activities of Daily Living; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D000671:Amputation, Surgical / Q000534:rehabilitation*; D005006:Ethnicity; D005260:Female; D050723:Fractures, Bone / Q000534:rehabilitation*; D006801:Humans; D007902:Length of Stay; D035002:Lower Extremity / Q000601:surgery; D008297:Male; D017533:Marital Status; D012047:Rehabilitation Centers; D012189:Retrospective Studies; D012737:Sex Factors; D012923:Social Class; D000071939:Stroke Rehabilitation; D061665:Time-to-Treatment; D016896:Treatment Outcome
keywords: Efficiency; Rehabilitation