Evaluation of outcomes, costs, and feasibility of home-based geriatric rehabilitation after inpatient rehabilitation: study protocol of the "Better@Home" multicentre prospective cohort study with historical control group

BackgroundThe increasing demands of an aging population, healthcare workforce shortages, financial constraints, and a shift in care perspectives call for rethinking geriatric rehabilitation (GR). To ensure GR remains sustainable, a transition towards home-based GR is proposed, reducing the need for prolonged inpatient GR. This study assesses the outcomes, costs and feasibility of the "Better@Home" program, in which home-based GR replaces part of inpatient GR.MethodsThis multicenter cohort study is conducted in eight GR facilities in the Netherlands, implementing the Better@Home program. Core elements of this program include replacing part of inpatient GR with home-based GR, focusing on participation goals, using eHealth, promoting self-management, and fostering close collaboration among all care partners. Data is gathered through semi-structured interviews, questionnaires, group interviews, registration forms, and electronic patient files.The Better@Home study is designed as a cohort study accompanied by a mixed-methods feasibility study. The study includes an outcome-and cost assessment. Within the cohort study, two evaluations can be distinguished. The first is a comparative evaluation, comparing the multicentre prospective Better@Home cohort with a historical control group on the primary outcome measure, as well as patient, family, and healthcare-related costs, from admission to completion of GR. The primary outcome measure of the comparative evaluation is independence in activities of daily living, assessed by the Barthel Index. The second is a follow-up evaluation, to assess the course of the outcomes and costs from GR admission to three months of follow-up after GR completion, solely in the Better@Home cohort. The primary outcome measure of the follow-up evaluation is participation, assessed by the Canadian Occupational Performance Measure. The mixed-methods feasibility study incorporates both quantitative and qualitative methods. It evaluates the program's reach, performance according to plan, active engagement of patients and informal caregivers, barriers and facilitators affecting implementation, and the opinions of patients, informal caregivers, and professionals on the program.MethodsThis multicenter cohort study is conducted in eight GR facilities in the Netherlands, implementing the Better@Home program. Core elements of this program include replacing part of inpatient GR with home-based GR, focusing on participation goals, using eHealth, promoting self-management, and fostering close collaboration among all care partners. Data is gathered through semi-structured interviews, questionnaires, group interviews, registration forms, and electronic patient files.The Better@Home study is designed as a cohort study accompanied by a mixed-methods feasibility study. The study includes an outcome-and cost assessment. Within the cohort study, two evaluations can be distinguished. The first is a comparative evaluation, comparing the multicentre prospective Better@Home cohort with a historical control group on the primary outcome measure, as well as patient, family, and healthcare-related costs, from admission to completion of GR. The primary outcome measure of the comparative evaluation is independence in activities of daily living, assessed by the Barthel Index. The second is a follow-up evaluation, to assess the course of the outcomes and costs from GR admission to three months of follow-up after GR completion, solely in the Better@Home cohort.The primary outcome measure of the follow-up evaluation is participation, assessed by the Canadian Occupational Performance Measure. The mixed-methods feasibility study incorporates both quantitative and qualitative methods. It evaluates the program's reach, performance according to plan, active engagement of patients and informal caregivers, barriers and facilitators affecting implementation, and the opinions of patients, informal caregivers, and professionals on the program.DiscussionThis study offers insights into the potential of home-based GR. The multicentre and multilayered design enables a comprehensive evaluation of the Better@Home program's outcomes, costs and feasibility, providing a basis for further optimization and upscaling of home-based GR.