05.04.2024

Neuropsychological online rehabilitation improves service availability and generates savings

Online rehabilitation will save the society nearly €1 million by 2026 and saves almost an entire working day's worth of time for professionals compared to a traditional treatment period, according to calculations based on a model jointly produced by HUS and KPMG.

- The digital care pathway for neuropsychological online rehabilitation replaces the face to face treatment sessions entirely, or a part of the patient’s longer rehabilitation period. The care pathway includes eight sessions focusing on different topics. Short-term physical counselling typically involves 4–5 visits to a neuropsychologist, each session lasting around 60 minutes. Ultimately, an extra 6 hours 24 minutes of working time is saved. This implies that the digital care pathway has the potential to generate significant resource savings, says Eeva-Liisa Kallio, a Doctor of Psychology and neuropsychologist at HUS, who is the service manager of the care pathway.

Neuropsychological online rehabilitation is a nationwide service provided by HUS Neuropsychology. There is a demand for the service, as the current resources of neuropsychological rehabilitation cannot meet the regional or national needs of patients with milder symptoms. Patients who have almost fully recovered after acute treatment do not often receive neuropsychological rehabilitation and counselling due to a lack of resources.

- The scarcity of resources has resulted in queues for the neuropsychological rehabilitation services at HUS. The digital care pathway has made the service more available to patients with mild cerebrovascular accidents, and increased regional equality. The care pathway can provide the same service while taking up less professionals’ time, says Kallio.

Patients can access treatment immediately without any queues

Neuropsychological online rehabilitation is designed to provide information, self-assessment, guidance and symptom management training on neuropsychological symptoms after sudden brain injury.

The patient can start using the digital care pathway as they receive treatment from HUS. The welfare regions will provide a referral to HUS Neuropsychology, where the patient's suitability for the programme is evaluated. Patients are admitted to the care pathway from all over Finland and the service is available in Finnish and Swedish.

- This is a low-threshold service that is provided for patients entirely remotely. The patients can advance in their rehabilitation process at home and receive guidance from a neuropsychologist if they wish. The treatment starts without any queues as soon as the referral has been processed. This will increase the availability of the service and even those patients who cannot afford to visit the outpatient clinic every week will be able to access the service, says Kallio.

The patient can advance in their rehabilitation process at their own pace, but the neuropsychologist will monitor the progress, provide comments whenever necessary and answer any questions by the patient. Rehabilitation lasts for at least one month and about two months on average.

For the professionals, the pathway offers remote work opportunities and flexible working hours. The key advantage for the organisations is that the extra time can be reallocated to other work, such as patients who require more demanding rehabilitation.

Scientific study in progress

A randomised and controlled IRENE study on the usability and effectiveness of neuropsychological online rehabilitation was started in 2022. The study is currently work in progress and will continue until 2025.

The study will explore topics such as whether online rehabilitation reduces the harm caused by neuropsychological symptoms and whether the rehabilitation programme increases the patients' self-assessed functional capacity, management of cognitive symptoms and fatigue, mental well-being and quality of life. Another key question is whether the rehabilitation programme makes it easier for the patient to return to work.

How the benefit calculation was done

The financial effectiveness of the digital care pathways at HUS was evaluated jointly by the HUS Departments, IT Management and KPMG experts. The project produced a model for cost-benefit calculations, which can be used by different units in their calculations. 

The cost-benefit model calculates the extra time that the professionals save (digital care pathway versus traditional care), hourly wages of professionals, the number of patients per year, which all add up to the annual cost savings for the HUS Departments. A cumulative estimate of cost savings up to 2026 was also made.

The calculations for neuropsychological online rehabilitation were based on the model as follows:

• Online rehabilitation includes 8 sessions. A physical rehabilitation course of similar scale would require 5–6 appointments with a neuropsychologist, so the online format would save the professionals an extra 6 h 24 min of working time.
• The factors taken into account in calculating the financial benefits for patients include lost working time, travel costs and co-payments for visits to the clinic.
• The neuropsychologist's salary costs based on the time spent on patient work on the care pathway versus the outpatient clinic (12 min versus 80 min/patient/visit), and an estimated 20% of the working time of the neuropsychology service manager.

Read more about the cost-benefit calculations for digital pathways.

• The impact assessment of digital care pathways indicates: the greatest cost benefit is generated by scalability

The digital care pathway is a digital service that complements traditional healthcare and physical appointments. The digital care pathways provide information and support to patients for their conditions and allow them to contact the professionals treating them. Patient can access the pathway with a doctor's referral or through treatment. Using the service is free of charge for the patient.