Cargando…

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...

Descripción completa

Detalles Bibliográficos
Autores principales: Dieter, William B., Collins, John P., Guccione, Andrew A.
Formato: Online Artículo Texto
Lenguaje:English
Publicado: BioMed Central 2019
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
_version_ 1783421937830068224
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
work_keys_str_mv AT dieterwilliamb predictingoutcomeswithinaninnovativepostacuterehabilitationmodelforolderadults
AT collinsjohnp predictingoutcomeswithinaninnovativepostacuterehabilitationmodelforolderadults
AT guccioneandrewa predictingoutcomeswithinaninnovativepostacuterehabilitationmodelforolderadults