Read Full Text: Economic Effects of Occupational Therapy Services for Adults in Acute and Subacute Care Settings: A Systematic Review (This is a paid article, but we still thought it was important to cover.)
Journal: The American Journal of Occupational Therapy
Year Published: 2022
CEU Podcast: The Value of Acute and Postacute OT with Jeffrey Kou (CE Course)
I’ve always believed that one of the main selling points of occupational therapy is its cost-effectiveness.
But, this week’s research really made me think through the complexities of that statement—for the acute and subacute settings, at least.
Yes, there is a growing amount of research on the economic value of OT—and the initial findings are promising.
The problem is that the existing research is widely varied, and there simply is not enough of it. Luckily, this article provides a great introduction to the topic, and it may add some nuance to the way you think about the value of your OT offerings.
Personally, I’m going to revise my pitch to say OT can be cost effective 
Let’s dive in.
Intro to OT in acute and subacute settings
This article begins with a helpful overview of OT in acute and subacute settings. The authors state that current research supports the clinical efficacy of OT in these settings to improve functional outcomes.
They point to these papers to back up that statement:
- Occupational Therapy Predischarge Home Visits in Acute Hospital Care (2016)
- Predischarge home visits after hip fracture (2019)
- Effectiveness of Interventions to Improve Occupational Performance of People With Motor Impairments After Stroke (2014)
- Effectiveness of acute in-hospital occupational therapy for older patients with hip fracture (2019)
However, just because care is deemed clinically effective does NOT necessarily mean it is cost effective. To understand the cost-effectiveness of OT, we need to answer the following questions:
- Are the functional gains even worth the cost and effort?
- Is there a cheaper/easier way to obtain these same gains?
What do we already know about the economic value of OT?
The authors state that evidence supporting the economic value of OT is emerging.
Previous reviews have illustrated the cost-effectiveness of:
But even though OT is widely considered an integral part of acute and post acute care, no synthesis of cost-effectiveness has been performed for these settings.
Which leads us to this paper…
What was the purpose of this paper?
The intent of this paper was to identify, describe, critique, and synthesize the published economic evaluations of OT for adults in acute and subacute care.
What were the methods?
The authors embarked on a systematic review to find research that:
- Focused on OT for adults in the acute and subacute settings.
- Provided a cost analysis.
To be included in this review, the research had to draw a comparison between OT and another intervention—like standard or usual care.
Data was extracted from the studies using the Joanna Briggs Institute Data Extraction Form for Economic Evaluation.
What were the results?
This review included 10 articles. Due to the heterogeneity of the results, the authors were unable to draw overarching conclusions about the economic value of OT services.
But, they did group the articles into 4 categories that are helpful when considering the cost-effectiveness of OT in various applications. I’ve done my own coding of this, giving the categories a red, yellow, or green light to visually represent the cost effectiveness associated with each:
Higher Cost and Lower Benefit
Lower Cost and Lower Benefit (no studies were in this category)
Higher Cost and Higher Benefit
Lower Cost and Higher Benefit
Here are the 10 studies, grouped by population and coded by cost-effectiveness:
Acute care
A 1998 study explored a discharge planning service that included a home visit from the OT. The cost of the service was $18,286, but it saved an estimated $519,780 by reducing readmission and bed days.
Older adults
A 2013 study showed that a falls education program saved about $451 per number of people with falls prevented.
A 2018 study investigated a discharge planning program with pre- and post-discharge home visits. The cost of the program was higher than that of the in-hospital consultation. However, compared to patients who underwent the in-hospital consultation, a higher proportion of patients in the home visit program showed improvement in activities of daily living, with a cost-effectiveness ratio of $61,906 per person who showed clinically meaningful improvement.
Post-stroke
A 2017 article examined the use of the Aid for Decision-Making in Occupational Choice to identify meaningful occupations (and subsequently choose occupation-focused interventions). The chosen intervention was less expensive and more effective than usual care.
A 2019 study compared conventional treatment only to conventional treatment and 20 minutes of virtual reality (VR) rehab. The addition of VR rehab reduced overall costs and improved outcomes.
A 2014 study found that home visits pre-discharge were more expensive—but more effective—compared to hospital-based interviews.
A 2003 study found that an interdisciplinary NDT-based stroke rehab program provided no additional benefit and was more costly than standard care.
Subacute care
A 2008 study investigated the effect of pre- and post-op OT and PT for clients undergoing hip replacement. Compared to usual care, the intervention was less expensive and provided a greater benefit.
A 2019 study looked at a program where patients with TBI received structured ADL training during post-traumatic amnesia. Compared to the usual treatment, this program was less expensive ($42,863 versus $49,278) and more effective.
Another 2019 study took place in an inpatient rehab setting where clients received rehab services in which the challenge and skill level were adjusted to ensure the activities met the clients’ needs. Compared to the usual treatment, outcomes were better—but the cost was higher.
Conclusions and discussion
Overall, 5 interventions were found to deliver a higher benefit at a lower cost than the control:
- A discharge planning service that included a home visit from the OT
- Occupation-focused interventions post-stroke
- Conventional treatment with an additional 20 minutes of virtual reality rehab post-stroke
- Pre- and post-op OT and PT for clients undergoing hip replacement
- A program where patients with TBI received structured ADL training during post-traumatic amnesia
While these specific interventions showed promising results, it was difficult for the authors to draw any definitive, broadly-applicable conclusions about the cost-effectiveness of OT.
The authors contend that there has not been much professional discussion on the best way to measure the economic value of OT. They believe that because the clinical benefit of OT is often tied to the patient’s return to meaningful activity, we should seek to understand the cost of being limited in those activities—and subsequently, the related benefit of OT.
Implications for OT practitioners
This study showed that OT in acute and subacute care *can be” cost effective.
But, further research is needed. In the meantime, OTs should carefully document their costs and outcomes at an individual level.
Takeaways for OT practitioners
(Please note: These are my personal takeaways. They are not mentioned specifically in the article.)
1.) Talking in terms of money gives us a shared language—and we don’t do it enough!
Part of being client-centered means speaking a shared language with our clients. And honestly, money is probably the most universal language.
If we really want to connect with our teams and our clients, we need to get better at talking about the cost and benefits of what we offer. I’m very curious to hear what others think about this. Are you talking openly about the cost and benefits of your services?
2.) Every OT should understand the basic economics of their individual practice.
In every setting I worked in, one of the most empowering things I did was to learn and understand the policies that dictated:
- OT delivery
- The related payment mechanisms for OT
When you understand these two forces, you can harness them to provide the best care possible in your setting. I’m also curious to hear if you all feel the same way about this. Do you believe you have a solid grasp on your setting’s payment models and policies?
Here’s the full APA citation for this article:
Wales, K., Lang, D., Rahja, M., Somerville, L., Laver, K., &; Lannin, N. A. (2022). Economic effects of occupational therapy services for adults in acute and Subacute Care Settings: A systematic review. The American Journal of Occupational Therapy, 76(1).
Earn one hour of continuing education by listening to the podcast on this article!!
In this podcast episode, we dive even deeper into this topic, with OT (and Club member!), Jeffrey Kou. You may be eligible for continuing education credit for listening to this podcast. Please read our course page for more details!
