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Table 3 Summary of results pertaining to structures of care

From: Advancing aged care: a systematic review of economic evaluations of workforce structures and care processes in a residential care setting

Intervention Source Effectiveness Cost Randomised design Key findings
Enhanced staffing levels
 30–40 min of RN direct care time per resident per day vs. less than 10 min [20] + No Enhanced staffing levels have the potential to create cost savings from a societal perspective
Increasing nurse staffing in nursing homes demonstrated net reduction in re-hospitalisation, pressure ulcer presence, and urinary tract infections
Enhanced PT and OT services delivered improved functional status and reduced nursing costs
Occupational therapy has the potential to reduce secondary care costs including hospitalisation, and may uncover unmet needs for services
 Physical therapy and occupational therapy (PT/OT) staffing levels: 1:50 vs. 1:200 [28] + Yes
 1.0 FTE occupational therapist vs. usual care [35] + + No
 Off-hours physician coverage via telemedicine vs. on-call physician [34] + Yes Facilities accessing off-hours physician coverage via telemedicine had fewer resident hospitalisations than those facilities who did not utilise the telemedicine program or those who only had access to an on-call physician
Staffing configurations in specialised models of care
 FTE comparisons in Green House model vs. traditional institutional care [36] None + No Green house facilities provide more direct care time to residents compared to traditional units/facilities
There is an increase in direct care FTEs, which is offset by a reduction in administration and support staff FTEs
 Direct care time in Green House vs. traditional skilled nursing facilities [37] + No
 Special care unit (SCU) vs. traditional unit [23, 38, 44] ± + Yes Costs of care are higher on SCUs and in SCU facilities, than non-SCU facilities
Special care units provide more direct care time to residents compared to traditional units/facilities
 SCUs vs. traditional units in SCU facilities
 SCU facilities vs. non-SCU facilities
[24] None
Staff education
 Implementation of an evidence-based education and best practice program vs. usual training [29] + + Yes Evidence-based education programs show potential to reduce falls compared to non-evidence-based training
The potential for cost savings is highly dependent on the true cost of falls
  1. Effectiveness + intervention provides greater health benefit than comparator; 0 intervention provides equivalent health benefit to comparator; intervention provides lower health benefit than comparator
  2. Cost + intervention costs are higher than comparator; 0 intervention costs are equal to comparator; intervention costs are lower than comparator