Factors associated with success in transition care services among older people in Australia

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Abstract

Background

The Australian Transition Care Program (TCP) is a national intermediate care service aiming to optimise functional independence and delay entry to permanent care for older people leaving hospital. The aim of this study was to describe the outcomes of TCP and identify demographic and clinical factors associated with TCP ‘success’, to assist with clinical judgements about suitable candidates for the program.

Method

We conducted a descriptive cohort study of all older Australians accessing TCP for the first time between 2007 and 2015. Logistic regression models assessed demographic and clinical factors associated with change in performance on a modified Barthel Index from TCP entry to discharge and on discharge to community. Fine-Gray regression models estimated factors associated with transition to permanent care within 6 months of TCP discharge, with death as a competing event.

Results

Functional independence improved from entry to discharge for 46,712 (38.4%) of 124,301 TCP users. Improvement was more common with younger age, less frailty, shorter hospital stay prior to TCP, and among women, those without a carer, living outside a major city, and without dementia. People who received TCP in a residential setting were far less likely to record improved functional impairment and more likely to be discharged to permanent care than those in a community setting. Discharge to community was more common with younger age and among women and those without dementia. Nearly 12% of community TCP and 63% of residential TCP users had transitioned to permanent care 6 months after discharge. Entry to permanent care was more common with older age, higher levels of frailty, and among those with dementia.

Conclusions

More than half of TCP users are discharged to home and remain at home after 6 months. However, residential-based TCP may have limited efficacy. Age, frailty, carer status, and dementia are key factors to consider when assessing program suitability. Future studies comparing users to a suitably matched control group will be very helpful for confirming whether the TCP program is meeting its aims.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12877-020-01914-z.

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Most cited references 29

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Improving the sensitivity of the Barthel Index for stroke rehabilitation

Frank Vanclay, Betty Cooper, Surya Shah (1989)

The Barthel Index is considered to be the best of the ADL measurement scales. However, there are some scales that are more sensitive to small changes in functional independence than the Barthel Index. The sensitivity of the Barthel Index can be improved by expanding the number of categories used to record improvement in each ADL function. Suggested changes to the scoring of the Barthel Index, and guidelines for determining the level of independence are presented. These modifications and guidelines were applied in the assessment of 258 first stroke patients referred for inpatient comprehensive rehabilitation in Brisbane, Australia during 1984 calendar year. The modified scoring of the Barthel Index achieved greater sensitivity and improved reliability than the original version, without causing additional difficulty or affecting the implementation time. The internal consistency reliability coefficient for the modified scoring of the Barthel Index was 0.90, compared to 0.87 for the original scoring.

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Construction and characteristics of the RxRisk-V: a VA-adapted pharmacy-based case-mix instrument.

Kevin Sloan, Anne Sales, Chuan-Fen Liu … (2003)

Assessment of disease burden is the key to many aspects of health care management. Patient diagnoses are commonly used for case-mix assessment. However, issues pertaining to diagnostic data availability and reliability make pharmacy-based strategies attractive. Our goal was to provide a reliable and valid pharmacy-based case-mix classification system for chronic diseases found in the Veterans Health Administration (VHA) population. To detail the development and category definitions of a VA-adapted version of the RxRisk (formerly the Chronic Disease Score); to describe category prevalence and reliability; to check category criterion validity against ICD-9 diagnoses; and to assess category-specific regression coefficients in concurrent and prospective cost models. Clinical and pharmacological review followed by cohort analysis of diagnostic, pharmacy, and utilization databases. 126,075 veteran users of VHA services in Washington, Oregon, Idaho, and Alaska. We used Kappa statistics to evaluate RxRisk category reliability and criterion validity, and multivariate regression to estimate concurrent and prospective cost models. The RxRisk-V classified 70.5% of the VHA Northwest Network 1998 users into an average of 2.61 categories. Of the 45 classes, 33 classes had good-excellent 1-year reliability and 25 classes had good-excellent criterion validity against ICD-9 diagnoses. The RxRisk-V accounts for a distinct proportion of the variance in concurrent (R2 = 0.18) and prospective cost (R2 = 0.10) models. The RxRisk-V provides a reliable and valid method for administrators to describe and understand better chronic disease burden of their treated populations. Tailoring to the VHA permits assessment of disease burden specific to this population.

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Factors affecting short-term rehabilitation outcomes of disabled elderly patients with proximal hip fracture.

Carolyn Weiss, Shai Brill, Avital Hershkovitz … (2007)

To identify factors associated with postacute rehabilitation outcome of disabled elderly patients with proximal hip fracture. Geriatric rehabilitation center. One hundred thirty-three older patients. Not applicable. FIM instrument, motor FIM score, absolute functional gain on the FIM and motor FIM scores, relative functional gain on the FIM and motor FIM scores, rate of improvement on the FIM and motor FIM scores, proportion of patients discharged to home, and length of stay (LOS). Mean FIM score improved by 14 points (22%) with a functional gain rate of .56 point per day. No significant differences (P>.05) were found between weight-bearing and non-weight-bearing patients regarding the above outcome measures. Functionally independent and cognitively intact patients achieved significantly better score changes and rates of improvement and showed a higher ability to extract their rehabilitation potential than dependent and cognitively impaired patients. Their LOSs were significantly shorter. Patients with latency time (time delay from fracture to operation) of more than 5 days and patients with a history of stroke had significantly longer LOSs. Mini-Mental State Examination score, albumin levels on admission, and prefracture functional status were the most important parameters associated with FIM discharge scores (r=.756) and relative functional gain on the FIM (r=.583). Depression was the most important factor associated with LOS in patients with weight-bearing instructions on admission. The presence of a caregiver was the significant predictive value variable for returning home. Cognitive function, nutritional status, preinjury functional level, and depression were the most important prognostic factors associated with rehabilitation success of older patients with proximal hip fracture. Of these, depression and nutritional status are correctable, and early intervention may improve rehabilitation outcome.

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Author and article information

Contributors

Monica Cations:

ORCID: http://orcid.org/0000-0002-9262-0463

monica.cations@flinders.edu.au

Journal

Journal ID (nlm-ta): BMC Geriatr

Journal ID (iso-abbrev): BMC Geriatr

Title: BMC Geriatrics

Publisher: BioMed Central (London )

ISSN (Electronic): 1471-2318

Publication date (Electronic): 23 November 2020

Publication date PMC-release: 23 November 2020

Publication date Collection: 2020

Volume: 20

Electronic Location Identifier: 496

Affiliations

[1 ]GRID grid.430453.5, ISNI 0000 0004 0565 2606, South Australian Health and Medical Research Institute, ; PO Box 11060, Adelaide, SA 5001 Australia

[2 ]GRID grid.1014.4, ISNI 0000 0004 0367 2697, College of Medicine and Public Health, , Flinders University, ; Adelaide, SA Australia

Author information

Monica Cations http://orcid.org/0000-0002-9262-0463

Article

Publisher ID: 1914

DOI: 10.1186/s12877-020-01914-z

PMC ID: 7686713

PubMed ID: 33228558

SO-VID: 21acad75-fb1b-4a81-8ed7-2323f05282d0

License:

Open AccessThis article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/. 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 in a credit line to the data.

History

Date received : 16 June 2020

Date accepted : 17 November 2020

Funding

Funded by: South Australian Government Premier's Research and Industry Fund

Custom metadata

ScienceOpen disciplines: Geriatric medicine

Keywords: transition care,intermediate care,hospital avoidance,rehabilitation,older adults

Data availability:

ScienceOpen disciplines: Geriatric medicine

Keywords: transition care, intermediate care, hospital avoidance, rehabilitation, older adults

Factors associated with success in transition care services among older people in Australia

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Supplementary Information

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Cardiovascular Innovations and Applications

Most cited references 29

Improving the sensitivity of the Barthel Index for stroke rehabilitation

Construction and characteristics of the RxRisk-V: a VA-adapted pharmacy-based case-mix instrument.

Factors affecting short-term rehabilitation outcomes of disabled elderly patients with proximal hip fracture.

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