title: Relationship of patient volume and service concentration with outcome in geriatric rehabilitation.
abstract: OBJECTIVE
  Although geriatric rehabilitation (GR) is beneficial for restoration of activities and participation after hospitalization of vulnerable older persons, little is known about the optimal organization of care of these postacute facilities. This study examines the relationship of patient volume and service concentration with successful GR (short length of stay and discharge home) in skilled nursing facilities (SNFs).
  
  
  METHODS
  A national multicenter retrospective cohort study.
  
  
  METHODS
  All patients indicated for GR in a Dutch SNF.
  
  
  METHODS
  Nurses filled out digital registration forms from patient records. Patients were studied in 3 predefined diagnostic groups: total joint replacement, traumatic injuries, and stroke. Facility characteristics were obtained by structured telephone interviews with facility managers. Volume was based on the number of discharges in a 3-month period and categorized in low-, medium-, and high-volume facilities. Concentration was defined at the organizational level in which the population consists of 80% or more of 1 or 2 diagnostic groups, with the prerequisite of having a minimum of 10 rehabilitation beds.
  
  
  RESULTS
  From 88 facilities, 2269 GR patients (mean age 78.2 years [SD 9.7]; 68.2% female) were included. The median length of stay in the SNF was 45 days (interquartile range 23-81), 57% of the patients were discharged home, and 9.8% died during GR. Of patients with total joint replacement (n = 501), concentration was related to successful rehabilitation (odds ratio 5.7; 95% confidence interval 1.3-24.3; P = .020, adjusted for age and gender); this relationship was not found for patients with traumatic injuries or stroke. Volume showed no relation with successful rehabilitation in any of the 3 diagnostic groups.
  
  
  CONCLUSIONS
  This study may indicate that concentration in an SNF, as a proxy for specialization, favors successful GR in total joint replacement. This relationship was not found for the traumatic injuries or stroke groups, or for volume. The relation on functional outcome in GR needs further investigation.
authors.affiliation: Department of Public Health and Primary Care, Leiden University Medical Center, Leiden, The Netherlands; Department of Innovation and Development, Evean, Purmerend, The Netherlands. Electronic address: m.s.holstege@lumc.nl.
authors.forename: Marije S
authors.initials: MS
authors.lastname: Holstege
authors.forename: Ineke G
authors.initials: IG
authors.lastname: Zekveld
authors.forename: Monique A A
authors.initials: MA
authors.lastname: Caljouw
authors.forename: Peter Bob
authors.initials: PB
authors.lastname: Peerenboom
authors.forename: Romke
authors.initials: R
authors.lastname: van Balen
authors.forename: Jacobijn
authors.initials: J
authors.lastname: Gussekloo
authors.forename: Wilco P
authors.initials: WP
authors.lastname: Achterberg
mesh_terms: D000368:Aged; D019643:Arthroplasty, Replacement / Q000534:rehabilitation*; D001509:Bed Occupancy / Q000706:statistics & numerical data; D015331:Cohort Studies; D005260:Female; D006801:Humans; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D009426:Netherlands; D010351:Patient Discharge / Q000706:statistics & numerical data*; D063868:Patient Outcome Assessment; D012189:Retrospective Studies; D012866:Skilled Nursing Facilities; D000071939:Stroke Rehabilitation; D014947:Wounds and Injuries / Q000534:rehabilitation*
keywords: Geriatric rehabilitation; discharge destination; length of stay; postacute care