Telehealth versus in-person delivery of an occupational therapy home visiting service: A cost analysis

Introduction

It is important to understand the cost implications of occupational therapy home visiting services, delivered using different modalities, supporting patients after discharge from the hospital. This study aimed to compare the costs of an occupational therapy home visiting service delivered via telehealth compared to services delivered in person, including the costs associated with any resultant adverse events.

Methods

Cost analysis was conducted using data from a retrospective cohort study of adult patients recently discharged from two hospitals who received an occupational therapy home visiting service, including environmental assessment, provision of equipment, and home modifications. Health-care system costs were quantified and compared between telehealth and in-person delivery over the period 2020–2022. Total costs, cost per person, and cost savings, as well as contributors to cost savings, are reported.

Consumer and Community Involvement

This cost analysis study had no consumer or community involvement.

Results

Cost data were reviewed for a total of 537 patients (telehealth, n = 271, including 56 ‘hybrid’ patients; face-to-face, n = 266). In-person group had a greater number of overall encounters compared to the telehealth group, particularly with more frequent use of emergency and inpatient care. Telehealth resulted in a 34% cost reduction compared to in-person care, equivalent to $4 million in savings to the health-care system or a saving of $1186 per telehealth encounter. Telehealth savings were derived from lower number of inpatient and emergency encounters, as well as reduced patient-related travel expenses. For repeat emergency and inpatient encounters, the total cost was $601,909 (82%) less for fall events and $31,772 (33%) less for delirium events, whereas the cost was higher for pressure injury events ($430,161 vs. $29,313 in in-person group).

Conclusion

Telehealth occupational therapy home assessments yielded cost savings over traditional in-person visits, attributed to fewer inpatient and emergency visits and lower travel costs. The cost-saving effect was observed for fall and delirium events, but not for pressure injury events, suggesting it may not be appropriate for all conditions.

PLAIN LANGUAGE SUMMARY

Occupational therapists help patients recover at home after hospital stays. They assess home safety and provide education and equipment like rails and shower chairs. Usually, they visit patients' homes, which can be costly and time-consuming. This study explored if telehealth could be a cheaper alternative. Patients received occupational therapy between 2020 and 2022, after leaving hospital. The costs were collected from the hospital for service delivery, any health service use, and we looked at if these patients had any problems after discharge such as falls, pressure injuries, or delirium and the costs of these. Overall, telehealth was 34% cheaper, saving the health system around $4 million, or $1186 per visit. Most of the savings came from fewer hospital visits and less travel. But for pressure injuries, telehealth ended up costing more. This shows that telehealth may not be the best option for every situation. Telehealth can be helpful and cost less to deliver occupational therapy home visiting services; however, we need to make sure this is directed to the right patients.