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Economic evaluation of a nursing-led inpatient unit: the impact of findings on management decisions of service utility and sustainability

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harris r, richardson g, griffiths p, hallett n. & wilson-barnett j.(2005) Journal of Nursing Management13, 428–438

Economic evaluation of a nursing-led inpatient unit: the impact of findings on management decisions of service utility and sustainability Aims 

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. Method 

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 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.
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Keywords: cost-effectiveness analysis; economic evaluation; hospital utilization; intermediate care; nurse clinicians; randomized-controlled trial

Document Type: Research Article

Affiliations: 1: Research Fellow, Nursing Research Unit, King's College London, London 2: Research Fellow, Centre for Health Economics, University of York, York 3: Senior Lecturer, Florence Nightingale School of Nursing and Midwifery, King's College London, London 4: Chief Executive, Homerton Hospital NHS Foundation Trust, London 5: Professor, Florence Nightingale School of Nursing and Midwifery, King's College London, London, UK

Publication date: September 1, 2005

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