Buying Time I: a prospective, controlled trial of a joint health/social care residential rehabilitation unit for older people on discharge from hospital

Abstract

The study's objective was to determine the effectiveness of a joint NHS/Social Services rehabilitation unit (a form of intermediate care) for older people on discharge from community hospital, compared with 'usual' community services. This was a controlled clinical trial in a practice setting. The intervention was 6 weeks in a rehabilitation unit where individuals worked with care/rehabilitation assistants and occupational therapists to regain independence. Controls went home with the health/social care services they would ordinarily receive. Participants were from two matched geographical areas in Devon: one with a rehabilitation unit, one without. Recruitment was from January 1999 to October 2001 in 10 community hospitals. Study eligibility was assessed using the unit's inclusion/exclusion criteria: 55 years or older and 'likely to benefit from a short-term rehabilitation programme' ('potential to improve', 'realistic and achievable goals' and 'motivation to participate'). Ninety-four people were recruited to the intervention and 112 to the control. The mean (standard deviation) age was 81.8 (8.0) years. The main outcome measure was prevention of institutionalisation assessed by the number of days from baseline interview to admission to residential/nursing care or death ('survival-at-home time'). Secondary outcome measures were time to hospital re-admission over 12 months, quality of life and coping ability. There were no significant differences between the groups on any outcome measure. Adjusted hazard ratio (95% CI) for 'survival-at-home time' was 1.13 (0.70-1.84), and 0.84 (0.53-1.33) for 'time to hospital re-admission'. However, attending the unit was associated with earlier hospital discharge. Median (interquartile range) days in hospital for the intervention graph was 27 (20, 40), and for the control graph was 35 (22, 47) (U = 4234, P = 0.029). These findings suggest a stay in a rehabilitation unit is no more effective than 'usual' care at diverting older people from hospital/long-term care. Alternative service configurations may be as effective, having implications for tailoring services more specifically to individual need and/or user preferences. However, the unit did appear to facilitate earlier discharges from community hospital.

Factors that promote and hinder joint and integrated working between health and social care services: a review of research literature

“…, Trappes‐Lomax et al . ). The authors suggest that these results may reflect service user characteristics (Davey et al .…”

Interventions to reduce hospital readmissions in the elderly: in-hospital or home care. A systematic review

“…Moreover, 10 interventions also included a care plan elaborated by a geriatric team following discharge [11,12,[14][15][16]22,24,26,27] and three included a pharmaceutical care review [16,17,23]. In 11 interventions, some kind of follow-up was carried out, either through collaboration with the patient's general practitioner or the intermediate care services [12,15,18,19,[22][23][24]26], or through follow-up phone calls or outpatient geriatric consultations [12,15,16,18,22,26]. In only three studies did an intervention produce statistically significant differences to the control group in terms of reduced readmissions [14,16,25], and in one of them, this difference was only partial and it depended on the time period measured [16].…”

Buying Time II: an economic evaluation of a joint NHS/Social Services residential rehabilitation unit for older people on discharge from hospital

“…This economic evaluation ran alongside a prospective controlled trial of the effectiveness of residential rehabilitation (Trappes‐Lomax et al . 2005).…”

“…a number of participants had a ‘survival‐at‐home’ time of 365 days). A detailed rationale for choosing this as the primary outcome measure is given in Trappes‐Lomax et al . (2005).…”

“…(2005). This outcome was not statistically different between the two groups [unadjusted mean (95% CI); 1.28 (0.81–2.03)] (Trappes‐Lomax et al . 2005).…”