Admission and discharge indicators as aids in optimizing comprehensive rehabilitation services

This paper describes the development of a theoretical cost effectiveness model used to optimize admission and discharge decisions in comprehensive rehabilitation centers. Rehabilitation progress and outcome is conceptualized in terms of functional gains due to treatment. The model is constructed with three variables: functional level at admission (Barthel), Barthel function gained per unit cost (BUC) and the percentage improvement in function from admission to discharge. The theoretical model is then tested with data from a random sample of 97 spinal cord injured and 132 focal cerebral patients drawn from ten leading comprehensive rehabilitation centers located across the continental United States. The basic structure of the model is supported by the data and the use of such models as aids in managing patients, evaluating services, planning new programs, and developing computer simulation models of rehabilitation cost effectiveness is discussed.