Effectiveness of community hospital-based post-acute care on functional recovery and 12-month mortality in older patients: A prospective cohort study

a b s t r a c tPurpose: This prospective study aims to determine predictive factors for patients to be discharged to home after receiving post-acute care (PAC) services and to improve the case-finding criteria for PAC services in Taiwan. Methods: Elder patients admitted to Taichung Veterans General Hospital for treatment of an acute illness were assessed by simplified comprehensive geriatric assessment (CGA) and clinical evaluation. Patients with functional recovery potential were transferred to community hospitals for further PAC service. Discharging status from a PAC unit to a home or long-term care facility was recorded. Results: From patients were recruited. 40 patients didn't receive complete PAC service and the remaining 83 patients completed the program. Among the 83 patients that completed the program, 56 patients (67.5%) were discharged to home and 27 patients (32.5%) were transferred to long-term care facilities. The Barthel index (BI) before receiving PAC was low (35.0 AE 21.34) and all patients had below average nutrition. Using multiple logistic regression analysis, patients receiving prior orthopedic surgery, living with other people and in a malnourished state were more likely to be discharged to home after receiving PAC service. Conclusion: Two-thirds of PAC patients can be safely discharged to home after receiving PAC services. Patients who live with other people, have prior orthopedic surgeries, and have good nutritional status represented predictive factors for returning home safely.

Section: Participants and Programmentioning

confidence: 99%

Predictive factors for patients discharged after participating in a post-acute care program

Lee

Lin

Jseng

et al. 2012

“…63 The community hospitalbased intermediate care services in Taiwan also showed significant survival benefits for all patients with postacute care needs, including hip fracture. 64 However, currently, these successful models have not been included in the National Health Insurance reimbursement yet.…”

Section: Optimal Rehabilitation Strategymentioning

confidence: 99%

Orthogeriatrics in Taiwan: Overview and experiences

Chen

Peng

Liu

et al. 2011

Self Cite

a b s t r a c tHip fracture is one of the common surgical indications seen in the geriatric population. The perioperative assessment and care are complicated with multiple comorbidities in this patient group, and the complications and high mortality resulted from immobility. The geriatricians in the United Kingdom started to join the care of hip fracture patients with orthopedic surgeons since 1950s to facilitate the preoperative assessment and avoid unnecessary delay in surgery, to optimize the patients' conditions perioperatively and reduce complications, and to provide comprehensive rehabilitation and correct reversible medical conditions that may precipitate next falls and fractures. It has become a trend worldwide, for an increasing body of evidence has revealed that geriatrician-led multidisciplinary team care for hip fracture patients can detect more medical conditions, lower the mortality rate and length of hospital stay, and reduce the admission to the nursing homes because of diminished function. More prospective randomized studies are needed to further prove the efficacy of the care models and make the most of the service not only to patients suffering from hip fracture but also other geriatric syndromes. The incidence of hip fracture in Taiwan is approaching faster that in the Western world as the population ages rapidly. The care for hip fracture patients faces many challenges perioperatively, especially the lack of postacute destinations for care and rehabilitation after the implementation of new reimbursement system. It is an urgent need for more domestic trials and audits to create orthogeriatric models of our own.

“…The first community hospital-based PAC program was started in 2007 in Taiwan, 11 and it was introduced to other hospitals in 2009. From May to October of 2009, all older veterans admitted to the tertiary medical center were primarily screened by the nursing staff for PAC needs.…”

Section: Program and Participantsmentioning

confidence: 99%

Screening postacute care needs of hospital inpatients in Taiwan: A hospital-based study

Chou

Liang

Lin

et al. 2012

Self Cite

a b s t r a c tPurpose: To evaluate the postacute care (PAC) needs of elderly patients in a tertiary teaching hospital. Methods: All elderly veterans admitted to a tertiary medical center were screened for their needs for PAC services from May 1 to October 31, 2009. Case managers evaluated the inclusion/non-inclusion criteria while visiting patients before their discharge. Comprehensive geriatric assessment (CGA) was performed before their transfer, if they agreed to receive the PAC service in addition to the complete medical history review. Results: Overall, 409 elderly patients (96.8% male; mean age ¼ 80.4 AE 5.4 years) meeting the inclusion/ exclusion criteria were screened, and 103 (25.2%) had PAC service needs. All patients diagnosed with central nervous system and musculoskeletal conditions displayed a significant decrease (93.1 AE 10.8 to 43.6 AE 33.3, p < 0.001; 90.9 AE 14.6 to 40.4 AE 23.1, p < 0.001) in Barthel Index (BI), and were more likely to require PAC (41.1%, p ¼ 0.001 and 55.3%, p < 0.001). Most patients with PAC needs had multiple complex needs, including mobility problems (97.7%), risk of malnutrition (90.7%), polypharmacy (74.4%), cognitive impairment (53.5%), pain problems (41.9%), sleep problems (39.5%), urinary incontinence (32.6%), and depression (14.0%). Conclusion: One-quarter of the elderly veterans admitted to the tertiary medical center, especially patients with central nervous system and musculoskeletal conditions, required PAC. Furthermore, the presence of multiple complex care needs among these patients strongly supported the suggestion that PAC services should be provided through a multidisciplinary approach.