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April 2003

By Sarah Schmelling

In the surface, it seems pretty obvious: both good-quality and preventive care not only are beneficial to patients’ health, but also can be extremely cost-effective. Yes, that was cost-effective, meaning something that—in a time of such economic difficulty—can actually save people money. But if this idea is so clear, why is there a wealth of cost-effectiveness studies currently being conducted? And why do they give pause, even to the most financially savvy of us?

Here are two examples. The first, the final installment of a three-part study, concerned occupational therapy for seniors. Published last August in the Journal of the American Geriatrics Society,1 this report, by researchers at the University of Southern California, demonstrated that OT is “highly cost-effective, and a much better use of scarce health care resources than many other interventions routinely prescribed for patients,” lead author Joel Hay, PhD, said upon the study’s publication. This “Well-Elderly Study” spanned 15 months and included three groups of independent people over the age of 60. One group participated in an OT lifestyle-redesign program, another group engaged in organized activities without OT, and a third received no intervention. The group that received OT achieved significant quality-of-life improvements without increasing health care costs.

More recently, Marilyn Rantz, PhD, RN, FAAN, of the University of Missouri, Columbia, reported that good-quality care in nursing homes actually costs less than poor quality care. Her project, some results of which were published in the March/April Nursing Outlook,2 while a full report will be published in Geriatrics later this year, included 90 nursing homes providing varying levels of care. Results showed that the 21 homes providing “good” quality care had total median costs of $85.35 per resident per day, as compared to $92.31 in homes considered to have “poor” quality care. In total costs per year, this is a difference of $300,000 to over $400,000, depending on nursing home size.

Rantz says the important point practitioners can take from this study is that well-run, quality health care can be achieved without high costs. “What we discovered is that the homes with the best outcomes had other aspects in common. They had a team approach in place, consistent leadership, and lower turnover,” she says. In short, basic practices can make high-quality care simply cost less.

Again, all of this may be obvious to you in the field. So why make a big deal about such studies? Because apparently they are not being reported enough. With state and local budget cuts hitting home, many facilities are closing. Slightly farther afield, sports programs such as those described in two articles in this issue—our cover story, “Healing on Wheels,” (page 18) by Bonita J. Sawatzky, PhD, et al, and our interview with Robert Gailey, PhD, PT (page 24)—are also struggling financially. And these corners of health care are just the start. Cost-effectiveness studies, at a time like this, need to be fussed over. Yes, the focus should never stray from the actual work that is being done. But the world needs to know that not only can good-quality, preventive care benefit patients, it also can help with everyone’s bottom line.

—Sarah Schmelling
cwolski@medpubs.com

References

Hay J, Labree L, Luo R, et al. Cost-effectiveness of preventive occupational therapy for independent living adults. J Am Ger Soc. 2002;50:1381-1388.
Rantz M. Does good quality care in nursing homes cost more or less than poor quality care? Nursing Outlook. 2003;51(2).

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