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Original research
Impact of a financial incentive on early rehabilitation and outcomes in ICU patients: a retrospective database study in Japan
  1. Yudai Honda1,
  2. Jung-ho Shin1,
  3. Susumu Kunisawa1,
  4. Kiyohide Fushimi2,
  5. Yuichi Imanaka1,3
  1. 1Department of Healthcare Economics and Quality Management, Kyoto University Graduate School of Medicine, School of Public Health, Kyoto, Japan
  2. 2Department of Health Policy and Informatics, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo, Japan
  3. 3Department of Health Security System, Kyoto University Graduate School of Medicine, Centre for Health Security, Kyoto, Japan
  1. Correspondence to Professor Yuichi Imanaka; imanaka-y{at}umin.net

Abstract

Background Early mobilisation of intensive care unit (ICU) patients has been recommended in clinical practice guidelines. Therefore, the Japanese universal health insurance system introduced an additional fee for early mobilisation and/or rehabilitation, which can be claimed by hospitals when starting rehabilitation of ICU patients within 48 hours after their ICU admission. However, the effect of this fee is unknown.

Objective To measure the proportion of ICU patients who received early rehabilitation and the impact on length of ICU stay, the length of hospital stay and discharged to home after the introduction of the financial incentive (additional fee for early mobilisation and/or rehabilitation).

Design/methods We included patients who were admitted to ICU within 2 days of hospitalisation between April 2016 and January 2020. We conducted interrupted time series analyses to assess the effects of the introduction of the financial incentive.

Results The proportion of patients who received early rehabilitation immediately increased after the introduction of the financial incentive (rate ratio (RR) 1.293, 95% CI 1.240 to 1.349). The RR for proportion of patients received early rehabilitation was 1.008 (95% CI 1.005 to 1.011) in the period after the introduction of the financial incentive compared with period before its introduction. There was no statistically significant change in the mean length of ICU stay, the mean length of hospital stay and the proportion of patients who were discharged to home.

Conclusion After the introduction of the financial incentive, the proportion of ICU patients who received early rehabilitation increased. However, the effects of the financial incentive on the length of ICU stay, the length of hospital stay and the proportion of patients who were discharged to home were limited.

  • Health policy
  • Quality improvement
  • Implementation science
  • Health services research

Data availability statement

Data are available upon reasonable request. The datasets generated and/or analysed during this study are available from the corresponding author as well as from two alternative contact points on reasonable request, specifically, Office of Research Promotion, General Affairs and Planning Division, Kyoto University (E-mail: kikaku06@mail2.adm.kyoto-u.ac.jp; Tel: +81-75-753-9301) and the Ethics Committee, Graduate School of Medicine, Kyoto University (e-mail: ethcom@kuhp.kyoto-u.ac.jp).

https://doi.org/10.1136/bmjqs-2024-017081

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    Data availability statement

    Data are available upon reasonable request. The datasets generated and/or analysed during this study are available from the corresponding author as well as from two alternative contact points on reasonable request, specifically, Office of Research Promotion, General Affairs and Planning Division, Kyoto University (E-mail: kikaku06@mail2.adm.kyoto-u.ac.jp; Tel: +81-75-753-9301) and the Ethics Committee, Graduate School of Medicine, Kyoto University (e-mail: ethcom@kuhp.kyoto-u.ac.jp).

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    Footnotes

    • Contributors YH: Conceptualisation, software, formal analysis, writing—original draft, writing—review and editing, visualisation. JS: Conceptualisation, software, formal analysis, validation, investigation, data curation, writing—review and editing. SK: Conceptualisation, validation, investigation, data curation, resources, writing—review and editing. KF: Conceptualisation, data curation, writing—review and editing. YI: Conceptualisation, validation, investigation, resources, writing—review and editing, supervision, project administration, funding acquisition, guarantor.

    • Funding This study was funded by Ministry of Health, Labour and WelfareHealth and Labour Sciences Research Grants/Grant (JPMH21IA1005, JPMH22AA2003) and Japan Society for the Promotion of Science (JP23H00448).

    • Competing interests None declared.

    • Provenance and peer review Not commissioned; externally peer reviewed.

    • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.