Changes in geriatric rehabilitation: a national programme to improve quality of care. The Synergy and Innovation in Geriatric Rehabilitation study.
OBJECTIVE
To describe changes in the health service delivery process experienced by professionals, patients and informal caregivers during implementation of a national programme to improve quality of care of geriatric rehabilitation by improving integration of health service delivery processes.


METHODS
Sixteen skilled nursing facilities.


METHODS
Prospective study, comparing three consecutive cohorts.


METHODS
Professionals (elderly care physicians, physiotherapists and nursing staff) rated four domains of health service delivery at admission and at discharge of 1075 patients. In addition, these patients [median age 79 (Interquartile range 71-85) years, 63% females] and their informal caregivers rated their experiences on these domains 4 weeks after discharge.


RESULTS
During the three consecutive cohorts, professionals reported improvement on the domain team cooperation, including assessment for intensive treatment and information transfer among professionals. Fewer improvements were reported within the domains alignment with patients' needs, care coordination and care quality. Between the cohorts, according to patients (n = 521) and informal caregivers (n = 319) there were no changes in the four domains of health service delivery.


CONCLUSIONS
This national programme resulted in small improvements in team cooperation as reported by the professionals. No effects were found on patients' and informal caregivers' perceptions of health service delivery.
Department of Public Health and Primary Care, Leiden University Medical Center, Leiden, The Netherlands; Department of Research and Development, Evean, Purmerend, The Netherlands.
Marije S
MS
Holstege
Department of Public Health and Primary Care, Leiden University Medical Center, Leiden, The Netherlands.
Monique A A
MA
Caljouw
Department of Public Health and Primary Care, Leiden University Medical Center, Leiden, The Netherlands.
Ineke G
IG
Zekveld
Department of Public Health and Primary Care, Leiden University Medical Center, Leiden, The Netherlands.
Romke
R
van Balen
Department of General Practice and Elderly Care Medicine, VU University Medical Center, Amsterdam, The Netherlands.
Aafke J
AJ
de Groot
Department of Health Services Research, Maastricht University, Maastricht, The Netherlands.
Jolanda C M
JC
van Haastregt
Department of Health Services Research, Maastricht University, Maastricht, The Netherlands; Department of Family Medicine, Maastricht University, Maastricht, The Netherlands.
Jos M G A
JM
Schols
Department of General Practice and Elderly Care Medicine, VU University Medical Center, Amsterdam, The Netherlands.
Cees M P M
CM
Hertogh
Department of Public Health and Primary Care, Leiden University Medical Center, Leiden, The Netherlands.
Jacobijn
J
Gussekloo
Department of Public Health and Primary Care, Leiden University Medical Center, Leiden, The Netherlands.
Wilco P
WP
Achterberg
care process; geriatric rehabilitation; health service delivery; national programme; quality of care