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Effect of a Restorative Model of Posthospital Home Care on Hospital Readmissions
Author(s) -
Tinetti Mary E.,
Charpentier Peter,
Gottschalk Margaret,
Baker Dorothy I.
Publication year - 2012
Publication title -
journal of the american geriatrics society
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.992
H-Index - 232
eISSN - 1532-5415
pISSN - 0002-8614
DOI - 10.1111/j.1532-5415.2012.04060.x
Subject(s) - medicine , confidence interval , emergency department , odds ratio , ambulatory care , acute care , transitional care , inpatient care , medline , emergency medicine , family medicine , health care , nursing , pathology , political science , law , economics , economic growth
Objectives To compare readmissions of M edicare recipients of usual home care and a matched group of recipients of a restorative model of home care. Design Quasiexperimental; matched and unmatched. Setting Community, home care. Participants Seven hundred seventy individuals receiving care from a large home care agency after hospitalization. Intervention A restorative care model based on principles adapted from geriatric medicine, nursing, rehabilitation, goal attainment, chronic care management, and behavioral change theory. Measurements Hospital readmission, length of home care episode. Results Among the matched pairs, 13.2% of participants who received restorative care were readmitted to an acute hospital during the episode of home care, versus 17.6% of those who received usual care. Individuals receiving the restorative model of home care were 32% less likely to be readmitted than those receiving usual care (conditional odds ratio = 0.68, 95% confidence interval = 0.43–1.08). The mean length of home care episodes was 20.3 ± 14.8 days in the restorative care group and 29.1 ± 31.7 days in the usual care group ( P < .001). Results were similar in unmatched analyses. Conclusion Although statistical significance was marginal, results suggest that the restorative care model offers an effective approach to reducing the occurrence of avoidable readmissions. It was previously shown that the restorative model of home care was associated with better functional recovery, fewer emergency department visits, and shorter episodes of home care. This model could be incorporated into usual home care practices and care delivery redesign.