Cost-benefit of staff education in person-centered care of persons with dementia in Australian subacute rehabilitation

BACKGROUND: We assessed the cost-benefit of person-centered care education for direct care staff of an Australian subacute rehabilitation hospital, with respect to clinical outcomes and service costs of persons with dementia.

METHODS: In a nonrandomized pre/post/follow-up design, clinical outcomes and service use were evaluated for matched comparison (n=77) and intervention (n=80) groups for delirium incidence, accidents/injuries, injury treatment, psychotropic medicines, length of stay, hospital readmissions and discharge destination. Group-level outcomes were monetized and included in a cost-benefit analysis (present value of benefits/present value of education and service costs).

RESULTS: Relative to the comparison group, there were significant reductions in intervention group delirium (P=0.001), accidents/injuries (P=0.007), treatment for injuries (P=0.007), psychotropic medicines (P=0.030) and hospital readmission within 30 days (P=0.002). After adjusting for the longer length of stay of the intervention subgroup who contracted COVID-19 (n=10), there were no group differences in length of stay (P=0.83). Per participant service costs for comparison and intervention groups were AU$34,870 and AU$33,969, respectively, equating to a per-participant cost saving of AU$914 (P<0.0001).

CONCLUSION: Investment in person-centered care education of direct care staff is warranted from both clinical and economic perspectives.