Effect of a Restorative Model of Posthospital Home Care on Hospital Readmissions

Department of Medicine, Yale School of Medicine, New Haven, Connecticut 06520, USA.
Journal of the American Geriatrics Society (Impact Factor: 4.57). 08/2012; 60(8):1521-6. DOI: 10.1111/j.1532-5415.2012.04060.x
Source: PubMed


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.

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    • "Since then, the evidence base for a restorative approach to home care has been growing steadily. Until very recently, the research and evaluations providing this evidence have examined specific individual outcomes such as length of home-care episode (Tinetti et al. 2002), ongoing home-care use (Kent et al. 2000, Newbronner et al. 2007, McLeod & Mair 2009), hospital admissions (Tinetti et al. 2012), admission to residential care (Parsons et al. 2007), everyday functioning (Lewin & Vandermeulen 2010), self-rated health (Jones et al. 2009) and quality of life (Lewin & Vandermeulen 2010). Composite outcomes such as system-wide health and aged/social care service use and the associated cost have been reported by only one study as summarised below. "
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    ABSTRACT: Restorative home-care services, or re-ablement home-care services as they are now known in the UK, aim to assist older individuals who are experiencing difficulties in everyday living to optimise their functioning and reduce their need for ongoing home care. Until recently, the effectiveness of restorative home-care services had only been investigated in terms of singular outcomes such as length of home-care episode, admission to hospital and quality of life. This paper reports on a more complex and perhaps more significant measure - the use and cost of the home-care and healthcare services received over the 2-year period following service commencement. Seven hundred and fifty older individuals referred for government-funded home care were randomly assigned to a restorative or standard service between June 2005 and August 2007. Health and aged care service data were sourced and linked via the Western Australian Data Linkage System. Restorative clients used fewer home-care hours (mean [SD], 117.3 [129.4] vs. 191.2 [230.4]), had lower total home-care costs (AU$5570 vs. AU$8541) and were less likely to be approved for a higher level of aged care (N [%], 171 [55.2] vs. 249 [63.0]) during follow-up. They were also less likely to have presented at an emergency department (OR = 0.69, 95% CI = 0.50-0.94) or have had an unplanned hospital admission [OR (95% CI), 0.69 (0.50-0.95)]. Additionally, the aggregated health and home-care costs of the restorative clients were lower by a factor of 0.83 (95% CI 0.72-0.96) over the 2-year follow-up (AU$19,090 vs. AU$23,428). These results indicate that at a time when Australia is facing the challenges of population ageing and an expected increase in demand for health and aged care services, the provision of a restorative service when an older person is referred for home care is potentially a more cost-effective option than providing conventional home care.
    Full-text · Article · Jan 2014 · Health & Social Care in the Community
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    ABSTRACT: The objectives of this study were to determine whether older individuals who participated in a reablement (restorative) program rather than immediately receiving conventional home care services had a reduced need for ongoing support and lower home care costs over the next 57 months (nearly 5 years). Data linkage was used to examine retrospectively the service records of older individuals who had received a reablement service versus a conventional home care service to ascertain their use of home care services over time. Individuals who had received a reablement service were less likely to use a personal care service throughout the follow-up period or any other type of home care over the next 3 years. This reduced use of home care services was associated with median cost savings per person of approximately AU $12,500 over nearly 5 years. The inclusion of reablement as the starting point for individuals referred for home care within Australia's reformed aged care system could increase the system's cost effectiveness and ensure that all older Australians have the opportunity to maximize their independence as they age.
    Full-text · Article · Oct 2013 · Clinical Interventions in Aging
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    ABSTRACT: OBJECTIVE: To determine the impact of a restorative model of home care on social support and physical function among community-dwelling older people. DESIGN: Cluster randomized controlled trial SETTING: Home care in urban New Zealand PARTICIPANTS: 205 participants (mean age 79.1 years, 71.3% female, 81.5% New Zealand European (NZE) and 50.8% residing in areas of the highest levels of social deprivation (intervention group) and 76.9 years with 60.8% female, 73.2% NZE and 53.5% in the highest levels of social deprivation (usual care group). INTERVENTION: Participants randomized to the intervention group completed a goal facilitation tool with a Needs Assessor to determine their needs and to establish the aims for the episode of care. Services were structured according to the principles of restorative home care (independence focussed with individually tailored activity programs). Usual care participants received a standard needs assessment that informed the delivery of home care services. MAIN OUTCOME MEASURES: Short Physical Performance Battery, Dukes Social Support Index. RESULTS: There was greater change over time in physical function (measured by Short Physical Performance Battery [F=8.30, p=0.003]) but no associated increase in social support (as determined by Dukes Social Support Index [F=2.58, p=0.09]). CONCLUSIONS: Significant improvements in physical function were observed following a period of restorative home care services. The absence of an associated change in social support may have been the result of a combination of factors, including: the threshold of physical function required for community ambulation; the low rate of allied health service provision; and the time required to re-establish social ties.The findings contribute to greater understanding of factors necessary to refocus home based services to emphasise improvements in physical function and independence.
    No preview · Article · Feb 2013 · Archives of physical medicine and rehabilitation
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