Care home versus hospital and own home environments for rehabilitation of older people

Ward, Deborah; Severs, Martin; Dean, Taraneh; Brooks, Neon

doi:10.1016/s0031-9406(05)60023-5

Cited by 31 publications

(41 citation statements)

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“…Clearly, more research is needed to determine the best care settings and care pathways for patients with stroke [33]. Further research into the reasons for variation in care delivery and utilization among culturally and otherwise-diverse populations must address patient and family characteristics, as well as physician/other provider, facility, health system, and financial factors that contribute to decision-making and outcomes after stroke.…”

Section: Discussionmentioning

confidence: 99%

Disparities in Stroke Rehabilitation: Results of a Study in an Integrated Health System in Northern California

Sandel

Wang

Terdiman

et al. 2009

PM&R

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Objective To determine whether there are disparities in postacute stroke rehabilitation based on type of stroke, race/ethnicity, sex/gender, age, socioeconomic status, geographic region, or service area referral patterns in a large integrated health system with multiple levels of care. Design Cohort study tracking rehabilitation services for 365 days after acute hospitalization for a first stroke. Setting The Northern California Kaiser Permanente Health System (approximately 3.3 million membership population) Participants A total of 11,119 patients hospitalized for acute stroke from 1996 to 2003. The cohort includes patients discharged from acute care after a stroke. Postacute care rehabilitation services were evaluated according to the level of care ever-received within the 365 days after discharge from acute care, including inpatient rehabilitation hospital (IRH), skilled nursing facility (SNF), home health and outpatient, or no rehabilitation services. Interventions Not applicable. Main Outcome Measure Service delivery. Results Patients discharged to an IRH had longer lengths of stay in acute care. Patients with hemorrhagic stroke were less likely to be treated in an IRH. Patients whose highest level of rehabilitation was SNF were older and more likely to be women. After adjusting for age and other covariates, women were less likely to go to an IRH than men. Asian and black patients were more likely than white patients to be treated in an IRH or SNF. Also more likely to go to an IRH were patients from higher socioeconomic groups, from urban areas, and from geographic areas close to the regional rehabilitation hospital. Conclusions These results suggest variation in care delivery and extent of postacute care based on differences in patient demographics and geographic factors. Results also varied over time. Some minority populations in this cohort appeared to be more likely to receive IRH care, possibly because of disease severity, family support systems, cultural factors, or differences in referral patterns.

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Section: Discussionmentioning

confidence: 99%

Disparities in Stroke Rehabilitation: Results of a Study in an Integrated Health System in Northern California

Sandel

Wang

Terdiman

et al. 2009

PM&R

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“…Cross sectional work suggests that outcomes were better patients in long term care who received rehabilitation,10 11 but to date there is no evidence from intervention studies to support offering rehabilitation in a long term care setting or on the effectiveness of alternate sites and approaches 12…”

Section: Discussionmentioning

confidence: 99%

Transitional care facility for elderly people in hospital awaiting a long term care bed: randomised controlled trial

Crotty

Whitehead

Wundke

et al. 2005

BMJ

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Objective To assess the effectiveness of moving patients who are waiting in hospital for a long term care bed to an off-site transitional care facility. Design Randomised controlled trial. Setting Three public hospitals in Southern Adelaide. Participants 320 elderly patients (mean age 83 years) in acute hospital beds (212 randomised to intervention, 108 to control). Interventions A transitional care facility where all patients received a single assessment from a specialist elder care team and appropriate ongoing therapy. Main outcome measures Length of stay in hospital, rates of readmission, deaths, and patient's functional level (modified Barthel index), quality of life (assessment of quality of life), and care needs (residential care scale) at four months. Results From admission, those in the intervention group stayed a median of 32.5 days (95% confidence interval 29 to 36 days) in hospital. In the control group the median length of stay was 43.5 days (41 to 51 days) (95% confidence interval for difference 6 to 16 days).

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“…The Cochrane Effective Practice Organization [20,21] concluded that there was insufficient evidence to compare between the effect of a homebased strengthening program, and a hospital-based or outpatient clinic-based environment in the rehabilitation for elderly people. The main reasons were that description and specialization is often not clear, the components of the rehabilitation system were not adequately specified, and the control groups were not comparable with respect to the methodological criteria.…”

Section: Introductionmentioning

confidence: 99%

A comparative study of organized class-based exercise programs versus individual home-based exercise programs for elderly patients following hip surgery

Carmeli

Sheklow²,

Coleman

2006

Disability and Rehabilitation

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Both groups demonstrated improvement in a number of issues. However, there appears to be more positive health outcomes presented by the participants in the supervised/class-based group when compared to the non-supervised/home-based group. And therefore, patients may select to participate to either a home-based or class-based regime. The clinical relevance is the significant of the necessity for close supervision by a professional therapist. In addition, the results could have some political and economical implications on the healthcare system.

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Care home versus hospital and own home environments for rehabilitation of older people

Abstract: Care home versus hospital and own home environments for rehabilitation of older people.

Cited by 31 publications

References 1 publication

Disparities in Stroke Rehabilitation: Results of a Study in an Integrated Health System in Northern California

Disparities in Stroke Rehabilitation: Results of a Study in an Integrated Health System in Northern California

Transitional care facility for elderly people in hospital awaiting a long term care bed: randomised controlled trial

A comparative study of organized class-based exercise programs versus individual home-based exercise programs for elderly patients following hip surgery

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