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Predicting outcomes within an innovative post-acute rehabilitation model for older adults
BACKGROUND: Understanding the provision of health services to community-dwelling older adults is of great importance due to regulatory changes within post-acute care. The aim of this study was to illustrate pathways by which older adults, within an innovative post-acute care delivery model, move to...
Autores principales: | , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
BioMed Central
2019
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6537156/ https://www.ncbi.nlm.nih.gov/pubmed/31133006 http://dx.doi.org/10.1186/s12877-019-1147-6 |
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author | Dieter, William B. Collins, John P. Guccione, Andrew A. |
author_facet | Dieter, William B. Collins, John P. Guccione, Andrew A. |
author_sort | Dieter, William B. |
collection | PubMed |
description | BACKGROUND: Understanding the provision of health services to community-dwelling older adults is of great importance due to regulatory changes within post-acute care. The aim of this study was to illustrate pathways by which older adults, within an innovative post-acute care delivery model, move to either independence or re-admission back into higher levels of care to maximize the value of rehabilitation delivery. METHODS: Clinical data specific to an episode of care (n = 30,001) provided to Medicare beneficiaries treated via a rehabilitation house-calls model of care in their homes and senior living communites were separated into training and test sets. Classification trees were fit on the training set’s administrative and clinical variables. Descriptive statistics were calculated for the overall sample, patient characteristics, clinical characteristics, and clinical outcomes. RESULTS: Subjects were 83.3 years on average, 69.4% were female, and 62.2% were seen in their own homes while 37.8% were in senior living. The key variables predictive of progressing to independence were total number of visits, the presence of the Patient Specific Functional Scale (PSFS), PSFS score at discharge and change in PSFS. Prediction accuracy of the classification tree on the test set was 82.4%. CONCLUSIONS: Older adults progress to a higher degree of independence, instead of higher levels of care, via several distinct pathways within a rehabilitation house-calls model of care. A mix of service utilization and outcome variables are key predictors of each pathway and may be used to maximize the value of service delivery. Further examination of the predictors of outcome using administrative datasets drawn from different sub-sets of older adults across the post-acute care continuum is warranted. |
format | Online Article Text |
id | pubmed-6537156 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2019 |
publisher | BioMed Central |
record_format | MEDLINE/PubMed |
spelling | pubmed-65371562019-05-30 Predicting outcomes within an innovative post-acute rehabilitation model for older adults Dieter, William B. Collins, John P. Guccione, Andrew A. BMC Geriatr Research Article BACKGROUND: Understanding the provision of health services to community-dwelling older adults is of great importance due to regulatory changes within post-acute care. The aim of this study was to illustrate pathways by which older adults, within an innovative post-acute care delivery model, move to either independence or re-admission back into higher levels of care to maximize the value of rehabilitation delivery. METHODS: Clinical data specific to an episode of care (n = 30,001) provided to Medicare beneficiaries treated via a rehabilitation house-calls model of care in their homes and senior living communites were separated into training and test sets. Classification trees were fit on the training set’s administrative and clinical variables. Descriptive statistics were calculated for the overall sample, patient characteristics, clinical characteristics, and clinical outcomes. RESULTS: Subjects were 83.3 years on average, 69.4% were female, and 62.2% were seen in their own homes while 37.8% were in senior living. The key variables predictive of progressing to independence were total number of visits, the presence of the Patient Specific Functional Scale (PSFS), PSFS score at discharge and change in PSFS. Prediction accuracy of the classification tree on the test set was 82.4%. CONCLUSIONS: Older adults progress to a higher degree of independence, instead of higher levels of care, via several distinct pathways within a rehabilitation house-calls model of care. A mix of service utilization and outcome variables are key predictors of each pathway and may be used to maximize the value of service delivery. Further examination of the predictors of outcome using administrative datasets drawn from different sub-sets of older adults across the post-acute care continuum is warranted. BioMed Central 2019-05-27 /pmc/articles/PMC6537156/ /pubmed/31133006 http://dx.doi.org/10.1186/s12877-019-1147-6 Text en © The Author(s). 2019 Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated. |
spellingShingle | Research Article Dieter, William B. Collins, John P. Guccione, Andrew A. Predicting outcomes within an innovative post-acute rehabilitation model for older adults |
title | Predicting outcomes within an innovative post-acute rehabilitation model for older adults |
title_full | Predicting outcomes within an innovative post-acute rehabilitation model for older adults |
title_fullStr | Predicting outcomes within an innovative post-acute rehabilitation model for older adults |
title_full_unstemmed | Predicting outcomes within an innovative post-acute rehabilitation model for older adults |
title_short | Predicting outcomes within an innovative post-acute rehabilitation model for older adults |
title_sort | predicting outcomes within an innovative post-acute rehabilitation model for older adults |
topic | Research Article |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6537156/ https://www.ncbi.nlm.nih.gov/pubmed/31133006 http://dx.doi.org/10.1186/s12877-019-1147-6 |
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