Post-Acute Care for Older People Following Injury: A Randomized Controlled Trial

Matthew Parsons; John Parsons; Avinesh Pillai; Paul Rouse; Sean Mathieson; Rochelle Bregmen; Christine Smith; Tim Kenealy

doi:10.1016/j.jamda.2019.08.015

Post-Acute Care for Older People Following Injury: A Randomized Controlled Trial

J Am Med Dir Assoc. 2020 Mar;21(3):404-409.e1. doi: 10.1016/j.jamda.2019.08.015. Epub 2019 Oct 16.

Authors

Matthew Parsons¹, John Parsons², Avinesh Pillai³, Paul Rouse⁴, Sean Mathieson⁵, Rochelle Bregmen⁵, Christine Smith⁵, Tim Kenealy⁵

Affiliations

¹ Faculty of Medical and Health Sciences, The University of Auckland, Auckland, New Zealand; Waikato District Health Board, Hamilton, New Zealand. Electronic address: m.parsons@auckland.ac.nz.
² Faculty of Medical and Health Sciences, The University of Auckland, Auckland, New Zealand; Waikato District Health Board, Hamilton, New Zealand.
³ Faculty of Science, University of Auckland, Auckland, New Zealand.
⁴ The Business School, The University of Auckland, Auckland, New Zealand.
⁵ Faculty of Medical and Health Sciences, The University of Auckland, Auckland, New Zealand.

PMID: 31629646
DOI: 10.1016/j.jamda.2019.08.015

Abstract

Objectives: The study sought to determine whether older people, on discharge from hospital and on referral to a supported discharge team (SDT), will have: (1) reduced length of stay in hospital; (2) reduced risk of hospital readmission; and (3) reduced healthcare costs.

Design/intervention: Randomized controlled trial with follow-up at 4 and 12 months of post-acute home-based rehabilitation team (SDT). Programs were delivered by trained healthcare assistants, up to 4 times a day, 7 days a week, under the guidance of registered nurses, allied health, and geriatricians for up to 6 weeks.

Participants/setting: A total of 303 older women and 100 older men (mean age 81) in hospital because of injury, were randomized to either SDT (n = 201) or usual care (n = 202). The intervention was operated from Waikato hospital, a regional hospital in New Zealand.

Methods: Days spent in hospital in the year following randomization and healthcare costs were collected from hospital datasets, and functional status assessed using the interRAI Contact Assessment was gathered by health professional research associates.

Results: Participants randomized to the SDT spent less time in hospital in the period immediately prior to discharge (mean 20.9 days) in comparison to usual care (mean 26.6 days) and spent less time in hospital in the 12 months following discharge home. Healthcare costs were lower in the SDT group in the 12 months following randomization.

Conclusions/implications: SDT can provide an important role in reducing hospital length of stay and readmissions of older people following an injury. Almost a million older people (65+ years of age) a year in the US are hospitalized as a consequence of falls-related injuries, most often fractured hip. Hospitals are not always the best location to provide care for older people. SDTs can help with the transition from hospital to home, while reducing hospital length-of-stay.

Keywords: Supported discharge teams; post-acute care.

Publication types

Randomized Controlled Trial
Research Support, Non-U.S. Gov't

MeSH terms

Aged
Aged, 80 and over
Female
Hip Fractures*
Humans
Male
New Zealand
Patient Discharge
Patient Readmission
Subacute Care*