A pilot study: post-acute geriatric rehabilitation versus usual care in skilled nursing facilities.
OBJECTIVE
To compare discharge outcomes, postdischarge health care use, and death rates among patients treated in a postacute geriatric rehabilitation unit (GRU) housed within a skilled nursing facility (SNF) with those treated in a traditional SNF.


METHODS
Retrospective observational pilot study.


METHODS
Two similar SNFs were compared.


METHODS
All patients were admitted from the acute hospital to either the GRU (n = 95) or to the usual care (UC) SNF (n = 55).


METHODS
The GRU intervention consisted of comprehensive geriatric assessment and weekly interdisciplinary team rounds with a geriatrician and a geriatric nurse practitioner (GNP). The geriatrician visited the GRU twice a week and the GNP was present 4 to 5 times per week. On discharge, GRU patients were followed up with telephonic case management for 1 year.


METHODS
Demographic data collected included age, gender, and race. Information collected from each facility's patient records included admitting diagnosis, length of stay, discharge disposition, and functional outcomes. Emergency department (ED) visits and hospital readmissions for 1 year after discharge from the nursing facility were obtained from our institutional database. The Rehabilitation Outcome Measure (ROM) was used by each facility to measure functional status on admission and at the time of discharge.


RESULTS
Baseline patient characteristics were comparable between the 2 facilities. At discharge from the nursing facility, GRU patients showed greater improvement in ADLs and mobility, had a significantly shorter length of stay, and were discharged to home more often. At 1 year, GRU patients had significantly fewer hospital readmissions. GRU patients also had fewer ED visits and days in the hospital at 1 year, however these results were not significant.


CONCLUSIONS
These pilot results suggest that GRU may be an effective means to improve patient outcomes and reduce undesirable health care use after an acute illness. Further studies using a randomized design are needed.
Kauh
Bong
B
Division of Geriatric Medicine, Summa Health System, Akron, OH 44304, USA. kauhb@summa-health.org
Polak
Tracy
T
Hazelett
Susan
S
Hua
Keding
K
Allen
Kyle
K
D000203:Activities of Daily Living; D000359:Aftercare / Q000458:organization & administration*; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D003266:Continuity of Patient Care; D005260:Female; D050723:Fractures, Bone / Q000175:diagnosis / Q000401:mortality / Q000534:rehabilitation*; D015577:Geriatric Assessment; D006801:Humans; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D010351:Patient Discharge; D010359:Patient Readmission / Q000706:statistics & numerical data; D010865:Pilot Projects; D020127:Recovery of Function; D012047:Rehabilitation Centers / Q000458:organization & administration / Q000706:statistics & numerical data*; D012189:Retrospective Studies; D018570:Risk Assessment; D012737:Sex Factors; D012866:Skilled Nursing Facilities / Q000458:organization & administration / Q000706:statistics & numerical data*; D015996:Survival Rate