TY - JOUR
T1 - Successful Geriatric Rehabilitation
T2 - Effects on Patients' Outcome of a National Program to Improve Quality of Care, the SINGER Study
AU - Holstege, Marije S.
AU - Caljouw, Monique A. A.
AU - Zekveld, Ineke G.
AU - van Balen, Romke
AU - de Groot, Aafke J.
AU - van Haastregt, Jolanda C. M.
AU - Schols, Jos M. G. A.
AU - Hertogh, Cees M. P. M.
AU - Gussekloo, Jacobijn
AU - Achterberg, Wilco P.
PY - 2017/5/1
Y1 - 2017/5/1
N2 - Objective: To determine whether the implementation of a national program to improve quality of care in geriatric rehabilitation (GR) in the Netherlands improves successful GR in terms of independence in activities of daily living (ADL), discharge destination, and length of stay.Design: Prospective longitudinal study, comparing 2 consecutive cohorts: at the start of implementation (n = 386) and at 1 year after implementation (n = 357) of this program.Setting/Participants: Included were 16 skilled nursing facilities, 743 patients (median age 80 years, interquartile range 72-85; 64.5% females) indicated for GR and their health care professionals (elderly care physicians, physiotherapists, and nursing staff).Intervention: National program to stimulate self-organizing capacity to develop integrated care to improve GR service delivery in 4 domains: alignment with patients' (care) needs, care coordination, team cooperation, and quality of care.Measurements: Data on patients' characteristics, functional outcomes at admission and discharge, length of stay, and discharge destination were collected via an online questionnaire sent to health care professionals. The primary outcome measure was successful rehabilitation defined as independence in ADL (Barthel Index >= 15), discharge home, and a short length of stay (lowest 25% per diagnostic group). Generalized estimating equation analysis was used to adjust for age, gender, and clustering effects in the total population and for the 2 largest diagnostic subgroups, traumatic injuries and stroke. Results: In the total population, at 1 year postimplementation there was 12% more ADL independence [ odds ratio (OR) 1.59, 95% confidence interval (CI) 1.00-2.54]. Although successful rehabilitation (independence in ADL, discharge home, short length of stay) was similar in the 2 cohorts, patients with traumatic injuries were more successful 1 year postimplementation (OR 1.61, 95% CI 1.01-2.54). In stroke patients, successful rehabilitation was similar between the cohorts, but with more independence in ADL in the follow-up cohort (OR 1.99, 95% CI 1.09-3.63).Conclusions: This study shows that 1-year after the implementation of the Dutch national program to improve quality of care there was more independence in ADL at discharge, but the combined outcome of successful GR (independence in ADL, discharge home, short length of stay) was only significantly improved in patients with traumatic injuries. (C) 2016 AMDA - The Society for Post-Acute and Long-Term Care Medicine.
AB - Objective: To determine whether the implementation of a national program to improve quality of care in geriatric rehabilitation (GR) in the Netherlands improves successful GR in terms of independence in activities of daily living (ADL), discharge destination, and length of stay.Design: Prospective longitudinal study, comparing 2 consecutive cohorts: at the start of implementation (n = 386) and at 1 year after implementation (n = 357) of this program.Setting/Participants: Included were 16 skilled nursing facilities, 743 patients (median age 80 years, interquartile range 72-85; 64.5% females) indicated for GR and their health care professionals (elderly care physicians, physiotherapists, and nursing staff).Intervention: National program to stimulate self-organizing capacity to develop integrated care to improve GR service delivery in 4 domains: alignment with patients' (care) needs, care coordination, team cooperation, and quality of care.Measurements: Data on patients' characteristics, functional outcomes at admission and discharge, length of stay, and discharge destination were collected via an online questionnaire sent to health care professionals. The primary outcome measure was successful rehabilitation defined as independence in ADL (Barthel Index >= 15), discharge home, and a short length of stay (lowest 25% per diagnostic group). Generalized estimating equation analysis was used to adjust for age, gender, and clustering effects in the total population and for the 2 largest diagnostic subgroups, traumatic injuries and stroke. Results: In the total population, at 1 year postimplementation there was 12% more ADL independence [ odds ratio (OR) 1.59, 95% confidence interval (CI) 1.00-2.54]. Although successful rehabilitation (independence in ADL, discharge home, short length of stay) was similar in the 2 cohorts, patients with traumatic injuries were more successful 1 year postimplementation (OR 1.61, 95% CI 1.01-2.54). In stroke patients, successful rehabilitation was similar between the cohorts, but with more independence in ADL in the follow-up cohort (OR 1.99, 95% CI 1.09-3.63).Conclusions: This study shows that 1-year after the implementation of the Dutch national program to improve quality of care there was more independence in ADL at discharge, but the combined outcome of successful GR (independence in ADL, discharge home, short length of stay) was only significantly improved in patients with traumatic injuries. (C) 2016 AMDA - The Society for Post-Acute and Long-Term Care Medicine.
KW - Geriatric rehabilitation
KW - successful rehabilitation
KW - independence in ADL
KW - length of stay
KW - discharge destination
KW - quality of care
KW - HOSPITAL STAY
KW - VALIDATION
KW - LENGTH
KW - SCALE
U2 - 10.1016/j.jamda.2016.10.011
DO - 10.1016/j.jamda.2016.10.011
M3 - Article
C2 - 27939318
SN - 1525-8610
VL - 18
SP - 383
EP - 387
JO - Journal of the American Medical Directors Association
JF - Journal of the American Medical Directors Association
IS - 5
ER -