Article

OBJECTIVE: To evaluate the Siebens Domain Management Model (SDMM) for geriatric
inpatient rehabilitation (IR) to increase functional independence and
dispositions to home. DESIGN: Before and after study.
SETTING: IR facility.
PARTICIPANTS: During 2010 (preintervention), 429 patients aged >/=75 years who
were on average admitted to IR 8.2 days postacute care, and during 2012
(postintervention), 524 patients aged >/=75 years who were on average admitted to
IR 5.5 days postacute care. Case-mix group (CMG) comorbidity tier severity,
preadmission living setting, and living support were similar in both groups.
INTERVENTION: The SDMM involving weekly adjustments of IR care focused on
potential barriers to discharge home. MAIN OUTCOME MEASURES: FIM efficiency,
length of stay (LOS), and disposition rates to community/home, acute care, and
long-term care (LTC) to compare pre-/postintervention facility data and
comparison of facility to national CMG-adjusted data from the Uniform Data System
for Medical Rehabilitation for both years (2010/2012). RESULTS:
Pre-/postintervention group admission FIM scores were similar (t=2.96, P<.003),
but the preintervention group had on average 2.6 days greater LOS during IR and
greater time to onset of IR (8.2 vs 5.5d) from acute care. Preintervention FIM
efficiency was 2.1, whereas postintervention FIM efficiency was 2.76, a
significant difference (t=4.1, P<.0001). There were significantly more discharges
to the community in the postintervention group (74.4%) than the preintervention
group (58.5%, chi(2)=26.2, P<.0001). There were significantly fewer patients
discharged to LTC in the postintervention group (chi(2)=30.47, P<.0001). The
preintervention group did not significantly differ from the 2010 national data,
but the postintervention group significantly differed from the 2012 national data
for both greater FIM efficiency (t=-5.5, P<.0001) and greater discharge to
community (chi(2)=34, P<.0001). LOS decreased by 2.6 days in the postintervention
group compared with the preintervention group, whereas LOS decreased by only 0.6
days nationally from 2010 to 2012, a significant difference with postintervention
LOS lower than the national data (t=31.1, P<.0001). CONCLUSIONS:
Use of the SDMM
during IR in geriatric patients is associated with increased functional
independence and discharges to home/community and reduced institutionalization.
CI - Copyright (c) 2015 American Congress of Rehabilitation Medicine. Published by
Elsevier Inc. All rights reserved.

Langue : ANGLAIS