Evaluation of an innovative cost-effective programme for brain injury patients: response to a need for flexible...

There is clinical support for the hypothesis that brain-injured patients benefit from the high degree of structure provided by an inpatient rehabilitation programme. However, they often experience mild to moderate regression in behavioural and functional skills when they are discharged to home. This paper presents an evaluation of an innovative phase within an acute brain injury programme designed to facilitate the patient's approach towards independence. 'Step-Up' programme patients, who spent the last weeks of their inpatient length of stay residing in a transitional living setting, were compared with inpatients who participated in the regular therapy programme. Eighteen months of descriptive data regarding cognitive (Rancho) and functional (Barthel) levels for 31 patients are compared. Based on survey data, the Step-Up patients reported more independence in activities of daily living than did inpatients. The Step-Up programme also proved to be more cost effective than the inpatient alternative. Challenges to innovative programming presented by payors, families, and clinicians are discussed.