@article{a133276a085d4da48015e712d2d3b8ab,
title = "Implementation of Post-Acute Rehabilitation at Home: A Skilled Nursing Facility-Substitutive Model",
abstract = "OBJECTIVES: For patients who require frequent and intensive therapy services after hospitalization, rehabilitation is predominantly provided in skilled nursing facilities (SNFs). Delivering post-acute rehabilitation in patientsʼ homes offers a potential alternative. Our aim was to describe and evaluate services and functional outcomes and then identify factors associated with the provision of a 30-day post-acute care (PAC) bundle of rehabilitation, medical, and social services provided via the Rehabilitation at Home (RaH) program. DESIGN: Single-arm retrospective review of patients participating in the RaH program. SETTING: Multidisciplinary home-based delivery of PAC in Manhattan. PARTICIPANTS: Individuals 18 years or older residing in a specified catchment area and qualifying for SNF-based rehabilitation services from October 2015 to September 2017. RESULTS: A total of 237 patients participated in RaH over 264 episodes of care. Participants were predominantly older than 85 years (57%; mean = 84.2; standard deviation [SD] = 10.0 years) and of non-Hispanic white (70%) race and ethnicity. Most were admitted after hospitalization (88.2%) for 117 different diagnostic related groups. Average length of stay in RaH was 14.2 (SD = 6.5) days with patients receiving 1.83 (SD = 2.22) medical provider, 1.67 (SD = 1.58) nursing, and 5.24 (SD = 1.05) physical therapist visits weekly. Most of the patients fully or almost fully met their goals for bed mobility (65%), bed transfer (69%), chair transfer (67%), and ambulation (64%) with the majority achieving moderate or considerable (61%) global functional improvement. Achieving moderate or considerable global improvement was negatively associated with dementia diagnosis (odds ratio [OR] =.23; 95% confidence interval [CI] =.08-.71) and positively associated with higher baseline ambulation (OR = 5.51; 95% CI = 2.22-13.66). At 30 days, 87.3% of participants were living in the community. CONCLUSION: Delivering SNF-level post-acute rehabilitation care in patientsʼ homes for a broad range of diagnoses is feasible and associated with functional improvement. This approach may help older adults maintain living status in the community. J Am Geriatr Soc 68:1584-1593, 2020.",
keywords = "geriatrics, home-based care, post-acute care",
author = "Augustine, {Matthew R.} and Claire Davenport and Ornstein, {Katherine A.} and Mitchell Cuan and Pamela Saenger and Sara Lubetsky and Alex Federman and DeCherrie, {Linda V.} and Bruce Leff and Siu, {Albert L.}",
note = "Funding Information: Research from this publication was supported by the US Department of Health and Human Services, Centers for Medicare & Medicaid Services (1C1CMS331334‐01‐00), the National Institute on Aging, Claude D. Pepper Older Americans Independence Center (TS, 3P30AG028741), and the John A. Hartford Foundation. Matthew R. Augustine was supported by the Empire Clinical Research Investigator Program awarded through the Department of Medicine at the Icahn School of Medicine at Mount Sinai. Funding Information: We especially thank the staff and collaborators of Rehabilitation at Home through Mount Sinai who made the program and evaluation possible. Research from this publication was supported by the US Department of Health and Human Services, Centers for Medicare & Medicaid Services (1C1CMS331334-01-00), the National Institute on Aging, Claude D. Pepper Older Americans Independence Center (TS, 3P30AG028741), and the John A. Hartford Foundation. Matthew R. Augustine was supported by the Empire Clinical Research Investigator Program awarded through the Department of Medicine at the Icahn School of Medicine at Mount Sinai. Bruce Leff is a consultant for Medically Home and DispatchHealth. All other authors are either part- or full-time employees of the Icahn School of Medicine, which has an ownership interest in a joint venture with Contessa Health, a venture that manages acute care services provided to people in their homes through prospective bundled payment arrangements. These persons have no personal financial interest in the joint venture. Matthew R. Augustine possessed full access to the data, performed analyses, and takes responsibility for the integrity of the data and accuracy of the analyses. Study concept and design: All authors. Acquisition, analysis, or interpretation of data: Augustine and Siu. Preparation of manuscript: Augustine and Davenport. Critical revision of the manuscript: All authors. The sponsors had no role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; preparation, review, or approval of the manuscript; and decision to submit the manuscript for publication. Publisher Copyright: {\textcopyright} 2020 The American Geriatrics Society",
year = "2020",
month = jul,
day = "1",
doi = "10.1111/jgs.16474",
language = "English",
volume = "68",
pages = "1584--1593",
journal = "Journal of the American Geriatrics Society",
issn = "0002-8614",
publisher = "Wiley-Blackwell Publishing Ltd",
number = "7",
}