Substudy 10 Fact Sheet

Economic Evaluation of a Geriatric Day Hospital : Cost-Benefit Analysis Based on Functional Autonomy Changes (NA101-10)

Sponsor Organization:
Sherbrooke University

Rationale/Goals:
This project is one of fifteen sub-studies of the National Evaluation of the Cost-Effectiveness of Home Care Project (NA101). Pressures on the health care system are partly due to the needs of an aging population, and geriatric day hospital services are one response to the escalating demand for institutional care and services. Day services have the potential to decrease this demand by offering ambulatory treatment for elderly patients with disabilities related to poor physical health or psychosocial impairments. This study investigated the cost-effectiveness of a geriatric hospital day program, using a cost-benefit analysis based on changes in functional autonomy.

Activities:
The sample was composed of 151 patients admitted to the Geriatric Day Hospital (GDH) program at the Sherbrooke University Geriatrics Institute in the Province of Québec. Data from a previous longitudinal study tracking autonomy changes in 607 elderly people over 75 years of age living at home were used to create a comparison group. Functional autonomy (a means of measuring the ability to perform daily tasks) after admission and at discharge was assessed by a trained nurse using the Système de mesure de l'autonomie fonctionelle (SMAF). Based on financial reports, costs associated with resources consumed by the GDH were established. Benefits in dollars per day were estimated through regression equations based on functional autonomy changes related to the GDH program. A scenario for spreading the benefit per day was proposed: the median time from survival analysis to institutionalisation or death from the comparison group.

Key Findings:
The project leaders identified the following outcomes:

• For each dollar invested in care, $2.14 of benefits were derived in terms of improvement in functional status.
  
• A measurement of dollar benefits alone does not incorporate other important aspects for clients such as improvement in cognitive function, socialization, and well-being. As a result, the findings of a 114 per cent cost-benefit may in fact be the lower limit of the possible benefit of such hospitals.

Implications:
The project leaders indicated that their findings are important because, in their view:

• The results give policy-makers more information on the economic aspects of geriatric day hospital programs for their decisions about budget allocations for health care for the elderly.
  
• Health policy-makers will need to grapple with the issue of optimal length of stay for patients
• Too long or too short a stay may increase the costs or reduce the benefits.
  
• The study was conducted in the absence of a true control group, and other studies using this methodology need to be done to determine the benefits of day hospitals related to different interventions, or no interventions at all.
  

Evaluation Methodology:
As this was an evaluation project, please see the "Activities" section.

HTF Contribution to the Project:
$1,505,000 (divided among the 15 sub-studies)

Language of Report:
English

• Executive summary
• Full report