Stroke Rehabilitation Care Pathway Informed by Time-Driven Activity-Based Costing

Background: Stroke is still the leading global cause of mortality and morbidity. To address its social and financial burden, the Early Supported Discharge Program (ESD) can be an effective in addition to telerehabilitation. While evidence supports this approach, limited knowledge exists regarding the cost of such interventions relative to the potential benefits. Leveraging the principles of value-based healthcare, Time-Driven Activity-Based costing (TDABC) is a method used to estimate the costs of healthcare resources. The aim of this study was to use the TDABC in estimating the costs of the ESD program, before and after the introduction of virtual healthcare during the COVID-19 pandemic. Methods: Participants in this pre-post study included patients and the interdisciplinary clinical team. The TDABC approach was used through five key steps: 1) mapping of care pathways, 2) estimating the duration of interventions, 3) determining clinicians’ practical capacity, 4) estimating the unit costs, and 4) determining the overall and per patient cost of care pathway. Data sources included administrative data on clinical teams’ salaries, indirect costs, clinical data and dashboard data. Descriptive data analysis of sociodemographic, clinical characteristics and estimation of costs per patient and trajectory were conducted. Results: In total, 108 patients, predominantly men (51%), aged 76 and over (46%), received rehabilitation services in 2019–2021. A large proportion of participants sustained an ischemic stroke (84%). Virtual healthcare represented 48 % of care from total direct services in 2020-2021. The average total time of interventions per patient increased from 4,299.8 minutes in 2019/2020 to 7,115.3 minutes in 2020/2021, leading to a direct cost per patient of $4,048.96 and $6511.68, respectively. The total cost of the ESD program was higher in 2020/2021 ($7,301.03) compared 2019/2020 ($4,782.78). Across the two time periods, the average age at admission increased, whereas patients' level of independence at admission declined. Conclusions: TDABC is an informative and feasible cost modelling methodology for programs such as ESD within a continuum of care integrating telerehabilitation. As a value-based healthcare approach, its application provides a framework to identify process improvements for rehabilitation services in ESD programs.