- Cost-effectiveness of Adult Day Care Services
- The researcher conducted Cross-Sectional 3 months and retrospective Case-Control study for 6 months for the period from November 2010 to July 2011. From the patients admitted to the Rehabilitation Center, the researcher identified those sustaining injuries because of mechanical fall. The researcher identified those who underwent different type of medical treatment including orthopedic surgeries due to various injuries. The researcher Identified and examined the medical records (n=179) of patients. All the male and female participants who were under the Medicare insurance were more than 65 years old. The researcher reviewed the charts and identified the legal number of patients enrolled to Adult Day Care Services. The researcher calculated Relative Risk ratio and established prevalence of falls injuries in population enrolled to Adult Day Care Services. This allowed calculating and comparing health care cost for Adult Day Care Services versus health care cost incurred due to fall’s injuries.
- The researcher derived sample size calculations basing on the primary hypothesis. The enrolment to Adult Day Care Services was associated with decrease number of injuries due to mechanical fall during unsupervised care. In order to estimate the sample size, the researcher used the number of patients with injuries caused by mechanical fall. The only variable that was to manipulate to power the study was the number of enrolment to ADCS. The researcher discovered that from 179 patients who sustained injuries due to fall, 69 patients successfully enrolled to Adult Day Care Services. The 69 patients signify that this number is 27 % of sample size. Accordingly, 63% people in sample size failed to enroll to Adult Day Care Services. Researcher calculated Relative risk of 16. This ratio shows that the old people who fail to enroll to ADCS are sixteen times prone to sustain injury due to mechanical fall versus those enrolled. The study showed that the prevalence of injuries in elderly who fail to enroll to ADCS is 16.
- Financial data came from the rehabilitation center micro-costing database and from government websites (CHA, 2011). Analyzing the cost instead of charging and reimbursement was easy because market alteration or deficiency may significantly influence the relationship between prices (charges) and resource requirement (cost). Hospitals tend not to adjust the pricing for each charge code in order to bring the charge value in line with the item’s current cost. Thus, the relationship between charge values and item’s actual cost may be inconsistent.
- The researcher used the T-test to analyze the collected data. After analyzing the data, the researcher compared the mean of the two groups. The two groups were from a single nominal variable. The researcher also calculated the mean cost for health care for fall’s injury of $41,763.00 per person. The mean length of stay including hospital and rehabilitation center was 29 days, and the mean cost of surgical care for fall injuries was $26,127.00. In this cost, the researcher excluded ancillary services, diagnostics test such as CT, MRI, X-ray, and medication cost. Addition of the cost of these services will increase the total cost of spending to about 50% more. After the calculations, the mean cost for health care for Adult Day Care Services was $61.00 per person per day.
- According to Relative Risk interpretation from 100 elderly enrolled to ADCS, only 10 people would sustain injuries due to fall. However, from 100 elderly people not enrolled to ADCS, 16 people would sustain fall injuries. The researcher used the difference of sixteen people to estimate cost-effectiveness of ADCS. After performing calculations, the researcher noted that in order to cater for Adult Day Care Services, government would spend $61 per day multiplied by 264 days that are only $16,104 per year per person. Estimated cost for the sixteen people is $96,624 per year. After calculating the p-value, the researcher acquired the output from T-test. P-value is <0.001 that confirms that study result is statistically significant. Confidential interval is 95%. The p-value is less than 0.05 and as a result, the null hypothesis that ADCS are not cost effective seemed to hold no value.
- Finally, calculation of spending in health care for fall injuries showed that the government would spend more than $41,763 per person. Estimated cost for six people was $250,578.00. Subtraction of these two calculations gave the difference of $153,954.00 that represents the amount of spending that the government can safe by providing ADCS to elderly people. The reliability of this conclusion is limited to demographic data that do not represent the number of sustained fall per person yearly. Regarding to the information obtained from the CDC, it is clear that one out of three adults age 65 and above fall every year. (CDC, 2011). US based national population projections show that population aging is likely to affect all US States. The projection illustrates that the US population will be slightly higher in 2020. In addition, the age structure of the population will be much older than it is now. The population of those people that work until at the old age may decline in future. The elderly people will play a significant role in increasing the percentage of population. Researchers estimate that by the year 2020, the percentage of those people above 65 years will be above 35. In 2009, the number of elderly people above the age of 65 accounted to 17.2% (U.S. Census Bureau, 2010).
- The limitation of this study is that there was only one rehabilitation center involved while conducting the research. Evidence for internal validity is in one of facility of the three affiliated hospitals that were providing services. However, the external validity remains unknown, and undoubtedly, it could improve by a larger sample of institutions. In addition, this study had a limited number of patients. In summary, the results of this study suggest that providing of ADCS is associated with decreasing in health care costs. However, the research obtained from the current observations indicates that it is limited because of inherent based on the study design. There is a need to continue with research in order to back the above findings with larger size and measuring the long-term costs and benefits providing ADCS to the elderly.
- References
- CHA. (2011). Exhibit and sponsor information. New York: Vail Cascade Resort.
- http://www.cha.com
- CDC. (2011). Injury Prevention and control: Homeland recreation safety. New York: Centre for disease control and prevention.
- http://www.cdc.gov/homeandrecreationalsafety/falls/adultsfa
- U.S. Census Bureau. (2010). American community survey. New York: Census Bereaus.
- http://census.gov/population/www/projection/natcha
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