Effect of a Restorative Model of Posthospital Home Care on Hospital Readmissions
ABSTRACT To compare readmissions of Medicare recipients of usual home care and a matched group of recipients of a restorative model of home care.
Quasiexperimental; matched and unmatched.
Community, home care.
Seven hundred seventy individuals receiving care from a large home care agency after hospitalization.
A restorative care model based on principles adapted from geriatric medicine, nursing, rehabilitation, goal attainment, chronic care management, and behavioral change theory.
Hospital readmission, length of home care episode.
Among the matched pairs, 13.2% of participants who received restorative care were readmitted to an acute hospital during the episode of home care, versus 17.6% of those who received usual care. Individuals receiving the restorative model of home care were 32% less likely to be readmitted than those receiving usual care (conditional odds ratio = 0.68, 95% confidence interval = 0.43-1.08). The mean length of home care episodes was 20.3 ± 14.8 days in the restorative care group and 29.1 ± 31.7 days in the usual care group (P < .001). Results were similar in unmatched analyses.
Although statistical significance was marginal, results suggest that the restorative care model offers an effective approach to reducing the occurrence of avoidable readmissions. It was previously shown that the restorative model of home care was associated with better functional recovery, fewer emergency department visits, and shorter episodes of home care. This model could be incorporated into usual home care practices and care delivery redesign.
SourceAvailable from: Monica Gupta[Show abstract] [Hide abstract]
ABSTRACT: Introduction: It has been estimated that re-hospitalisation may be accountable for almost half of all the hospital admissions in the elderly. Similarly studies have shown that re-hospitalisation account for up to 60% of hospital expenditure. Aim: To assess the potential reasons for re-hospitalisation of elderly medical patients and the outcome of these patients. Methodology: It was a hospital based cross-sectional observational study done from May 2011 to July 2011. All elderly (>60 years) patients readmitted to the General Medical Ward and Medical Emergency Wards were identified. Short admissions for therapeutic or diagnostic procedures were excluded. The patient’s diagnosis at time of current admission and the old records of past admissions were thoroughly scrutinized. The patient was followed up during his/her hospital stay and the outcome was assessed. Results: A total of 48 cases were identified. Fifty two percent of patients were re-hospitalised within 6 months (28% within a month, 6% in 2 months, 8% in 4 months and 10% in 6 months). Two or more comorbidities were present in 69% patients. Seventy three percent patients improved, 21% showed no change in status and 6% deteriorated. Disease related factors: 33% re-hospitalisation were found to be due to unavoidable relapse of underlying chronic disease, 25% due to failed trial with outpatient management, 17% due to complication of the underlying disease, 16% due to independent new disease, 5% due to adverse drug reaction and 4% due to decompensation of other co-morbid conditions. Patient’s related factors: 33% had perception of poor self rated general health, 27% premature discharge/inadequate rehabilitation, 24% had poor compliance to recommended prescription and 19% due to poor outpatient follow up. Conclusion: Our study shows that most of the re-hospitalisation were due to the relapses of underlying chronic diseases and were unavoidable. The other important findings were the poor perception of self rated general health, poor follow up with the outpatient clinic and non-compliance to drugs prescribed.
Dataset: Endelig PDF studie protokoll
[Show abstract] [Hide abstract]
ABSTRACT: As a result of the ageing population, there is an urgent need for innovation in community health-care in order to achieve sustainability. Reablement is implemented in primary care in some Western countries to help meet these challenges. However, evidence to support the use of such home-based rehabilitation is limited. Reablement focuses on early, time-intensive, multidisciplinary, multi-component and individualised home-based rehabilitation for older adults with functional decline. The aim of this study is to investigate the effectiveness of reablement in home-dwelling adults compared with standard treatment in relation to daily activities, physical functioning, health-related quality of life, use of health-care services, and costs.Methods/design: The study will be a 1:1 parallel-group randomised controlled superiority trial conducted in a rural municipality in Norway. The experimental group will be offered reablement and the control group offered standard treatment. A computer-generated permuted block randomisation sequence, with randomly selected block sizes, will be used for allocation. Neither participants nor health-care providers will be blinded, however all research assistants and researchers will be blinded. The sample size will consist of 60 participants. People will be eligible if they are home-dwelling, over 18 years of age, understand Norwegian and have functional decline. The exclusion criteria will be people in need of institution-based rehabilitation or nursing home placement, and people who are terminally ill or cognitively reduced. The primary outcome will be self-perceived performance, and satisfaction with performance of daily activities, assessed with the Canadian Occupational Performance Measure. In addition, physical capacity, health-related quality of life, use of health-care services, and cost data will be collected at baseline, and after 3 and 9 months in both groups, and again after 15 months in the intervention group. Data will be analysed on an intention-to-treat basis using a linear mixed model for repeated measures. The findings will make an important contribution to evaluating cost-effective and evidence-based rehabilitation approaches for community-dwelling adults.Trial registration: The trial was registered in ClinicalTrials.gov November 20, 2012, identifier: NCT02043262.BMC Geriatrics 12/2014; 13(139):17. DOI:10.1186/1471-2318-14-139 · 2.00 Impact Factor