Supporting at-risk older adults transitioning from hospital to home: who benefits from an evidence-based patient-centered discharge planning intervention? Post-hoc analysis from a randomized trial

Abstract

Background: Subgroups of older patients experience difficulty performing activities of daily living (ADL) following hospital discharge, as well as unplanned hospital readmissions and emergency department (ED) presentations. We examine whether these subgroups of "at-risk" older patients benefit more than their counterparts from an evidence-based discharge planning intervention, on the following outcomes: (1) independence in ADL, (2) participation in life roles, (3) unplanned re-hospitalizations, and (4) ED presentations. Trial design and methods: This study used data from a randomized control trial involving 400 hospitalized older patients with acute and medical conditions, recruited through 5 sites in Australia. Participants receive either HOME, a patient-centered discharge planning intervention led by an occupational therapist; or a structured in-hospital consultation. HOME uses a collaborative approach for goal setting and includes pre and post-discharge home visits as well as telephone follow-up. Characteristics associated with higher risks of adverse outcomes were recorded and at-risk subgroups were created (mild cognitive impairment, walking difficulty, comorbidity, living alone and no support from family). Independence in ADL and participation in life roles were assessed with validated questionnaires. The number of unplanned re-hospitalizations and ED presentations were extracted from medical files. Linear regression models were conducted to detect variation in response to the intervention at 3-months, according to patients' characteristics.

Effects, barriers and facilitators in predischarge home assessments to improve the transition of care from the inpatient care to home in adult patients: an integrative review

“…♀ 76% Control 82.9 (± 6.33, range n.r.) ♀ 80% Intervention Predischarge home visit Control Usual care ADL/IADL, Falls, re-hospitalization, institutionalization IADL [ 56 ], SMAF subscales [ 54 ] ADL subscales [ 57 ] number of recurring falls, mean number of fall recurrence in former fallers, number of re-hospitalizations, number of institutionalizations 12 Provencher et al, 2020 [ 27 ] a RCT, Post-hoc analysis Australia Acute care, unspecified n = 400 Intervention 80.2 (±6.4, range n.r.) ♀ 59.6% Control 80.7 (± 5.7, range n.r.)…”

Health professional and patient perspectives of factors associated with potentially avoidable hospitalisations in a rural Australian setting: a qualitative study

“…Australian study involving at risk older adults showed than an intervention to optimise discharge preparation and post discharge support in the community across ve sites signi cantly reduced unplanned admissions (22).…”

Educação em saúde no tratamento hospitalar pela fisioterapia: relato de experiência

“…A partir de informações da literatura, observou-se que as ações desempenhadas pelos projetos estão de acordo com as recomendações atuais a respeito do cuidado ao paciente e atenção à família, além do papel da equipe assistencial neste processo. Dentre estas ações, podemos elencar o cuidado centrado no paciente considerando a individualidade, atenção às necessidades funcionais como parte da recuperação da sua doença, promoção do autocuidado e inclusão da família como parte fundamental nos processos assistenciais que envolvem o cuidado (PROVENCHER et al, 2020;DAHLKE et al, 2019;PETRY et al, 2019;CHAN;SAMSUDIN;LIM, 2019).…”