Effectiveness of 'rehabilitation in the home' service

Abstract

Objectives. Rehabilitation in the home (RITH) services increasingly provide hospital substitution services. This study examines clinical outcomes in a large metropolitan RITH service in Western Australia.Methods. The 2010 database of Fremantle Hospital RITH service was interrogated to identify the clinical profile of cases, length of stay (LOS) and clinical outcomes. Negative outcomes included death or unexpected hospital readmission. Multiple logistic regression modelling was used to explore associations with negative outcomes. This study was reviewed by the Institutional Review Board which deemed it not to require ethics approval.Results. There were 1348 cases managed by RITH: 70.6% were aged !65 years; elective joint replacement (29.7%), medical conditions (20%), stroke (13%), hip fractures (10%) were major contributors. The majority (93.3%) were discharged after a median of 9 days. Negative outcomes occurred in 90 cases (6.7%), including five deaths (0.4%) and 85 readmissions (6.3%). Independent associations with negative outcomes included older age (odds ratio (OR) (95% CI); 1.02, P = 0.006), orthopaedic conditions (OR 1.91, P = 0.004) and longer inpatient LOS (OR 1.96, P = 0.003). Age above 80 years was independently associated with risk of negative outcome (OR 2.99, P = 0.004).Conclusions. RITH had a low rate of negative outcomes. The database proved useful for monitoring quality of service provision.What is known about the topic? Rehabilitation in the home environment has proven cost effective for multiple conditions, particularly stroke and elective joint surgery, among others, facilitating better quality of life, with reduced rates of delirium and mortality. Overall there are few negative outcomes and death is rare. What does this paper add? Although RITH services are widely utilised as bed substitution services, there is scant literature on clinical outcomes while within the service. This study focuses on frequency of good and poor clinical outcomes in a well-established RITH service in Western Australia, suggesting pattern recognition of an at-risk cohort by identifying potentially useful predictors of poor outcome. What are the implications for practitioners? RITH services are a safe alternative for many, including older people. Health administration databases are useful tools to monitor clinical outcomes. Clinical indicators such as older age, long hospital stay and orthopaedic diagnoses may be useful predictors of poor outcomes in such services.

Prevalence and Costs of Rehabilitation and Physical Therapy After Primary TJA

“…The value of home health services may vary by country. Rehabilitation in the home environment has proven cost effective in Western Australia for multiple conditions, including elective joint surgery, improving quality of life with reduced rates of mortality [42]. Conversely, although home PT was as effective and as acceptable to TKA patients undergoing outpatient hospital PT, it was more costly than treatment in the facility [43].…”

Geriatric home‐based rehabilitation in Australia: Preliminary data from an inpatient bed‐substitution model

“…Other studies have not described their patients in similar detail for direct comparison, however. 10,[15][16][17] Three-months after discharge, patients had improved functional independence and mobility compared to their home-based rehabilitation admission status but did not return to preadmission levels. This contrasts a study of similarly aged acutely hospitalized patients, which found comparable rates of ADL and IADL independence at hospital admission and three-months postdischarge.…”

“… 16 A retrospective chart review of home‐based rehabilitation patients (no age criteria, 70.6% aged ≥65 years) found that negative outcomes of hospital ward readmission or death occurred more frequently in older adults compared to younger adults. 17 However, this study did not report mobility, physical performance, or postdischarge outcomes, which are important considerations when evaluating hospital care for geriatric inpatients. 18 One retrospective study of a home‐based postacute rehabilitation service (mean age 84.2 years), found that most patients achieved their mobility goals and improved global function, and the authors provide a detailed description of the multidisciplinary care model.…”

Substituting inpatient rehabilitation beds for home‐based multidisciplinary rehabilitation: A qualitative study of patient perceptions

“…There is evidence of improved outcomes from home‐based rehabilitation care in a geriatric patient cohort compared to hospital‐based care, including lower odds of developing delirium, fewer hospital bed days and greater satisfaction regarding rehabilitation quality 2 . Similar positive results have been shown following orthopaedic surgery 3 and in several large trials following stroke, 4 with a low rate of negative outcomes being seen with home‐based rehabilitation care in a recent Western Australian study 5 . The concept of home‐based rehabilitation was also supported by the recent Travis Review of Victorian hospital capacity published in 2015 6 .…”

“…2 Similar positive results have been shown following orthopaedic surgery 3 and in several large trials following stroke, 4 with a low rate of negative outcomes being seen with home-based rehabilitation care in a recent Western Australian study. 5 The concept of home-based rehabilitation was also supported by the recent Travis Review of Victorian hospital capacity published in 2015. 6 This review recommended an expansion of home-based care options due to 'The potential benefits in patient outcomes and cost-effectiveness support further development of these models across the system (P10)'.…”