Successful Geriatric Rehabilitation: Effects on Patients’ Outcome of a National Program to Improve Quality of Care, the SINGER Study

Marije S. Holstege, Monique A.A. Caljouw, Ineke G. Zekveld, Romke van Balen, Jacobijn Gussekloo, Wilco P. Achterberg, Marije S. Holstege, Aafke J. de Groot, Cees M.P.M. Hertogh, Jolanda C.M. van Haastregt, Jos M.G.A. Schols, Jos M.G.A. Schols

Research output: Contribution to journalArticleAcademicpeer-review

Abstract

Objective To determine whether the implementation of a national program to improve quality of care in geriatric rehabilitation (GR) in the Netherlands improves successful GR in terms of independence in activities of daily living (ADL), discharge destination, and length of stay. Design Prospective longitudinal study, comparing 2 consecutive cohorts: at the start of implementation (n = 386) and at 1 year after implementation (n = 357) of this program. Setting/Participants Included were 16 skilled nursing facilities, 743 patients (median age 80 years, interquartile range 72–85; 64.5% females) indicated for GR and their health care professionals (elderly care physicians, physiotherapists, and nursing staff). Intervention National program to stimulate self-organizing capacity to develop integrated care to improve GR service delivery in 4 domains: alignment with patients’ (care) needs, care coordination, team cooperation, and quality of care. Measurements Data on patients’ characteristics, functional outcomes at admission and discharge, length of stay, and discharge destination were collected via an online questionnaire sent to health care professionals. The primary outcome measure was successful rehabilitation defined as independence in ADL (Barthel Index ≥15), discharge home, and a short length of stay (lowest 25% per diagnostic group). Generalized estimating equation analysis was used to adjust for age, gender, and clustering effects in the total population and for the 2 largest diagnostic subgroups, traumatic injuries and stroke. Results In the total population, at 1 year postimplementation there was 12% more ADL independence [odds ratio (OR) 1.59, 95% confidence interval (CI) 1.00–2.54]. Although successful rehabilitation (independence in ADL, discharge home, short length of stay) was similar in the 2 cohorts, patients with traumatic injuries were more successful 1 year postimplementation (OR 1.61, 95% CI 1.01–2.54). In stroke patients, successful rehabilitation was similar between the cohorts, but with more independence in ADL in the follow-up cohort (OR 1.99, 95% CI 1.09–3.63). Conclusions This study shows that 1-year after the implementation of the Dutch national program to improve quality of care there was more independence in ADL at discharge, but the combined outcome of successful GR (independence in ADL, discharge home, short length of stay) was only significantly improved in patients with traumatic injuries.

Original languageEnglish
Pages (from-to)383-387
Number of pages5
JournalJournal of the American Medical Directors Association
Volume18
Issue number5
DOIs
Publication statusPublished - 1 May 2017

Cite this

Holstege, Marije S. ; Caljouw, Monique A.A. ; Zekveld, Ineke G. ; van Balen, Romke ; Gussekloo, Jacobijn ; Achterberg, Wilco P. ; Holstege, Marije S. ; de Groot, Aafke J. ; Hertogh, Cees M.P.M. ; van Haastregt, Jolanda C.M. ; Schols, Jos M.G.A. ; Schols, Jos M.G.A. / Successful Geriatric Rehabilitation : Effects on Patients’ Outcome of a National Program to Improve Quality of Care, the SINGER Study. In: Journal of the American Medical Directors Association. 2017 ; Vol. 18, No. 5. pp. 383-387.
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title = "Successful Geriatric Rehabilitation: Effects on Patients’ Outcome of a National Program to Improve Quality of Care, the SINGER Study",
abstract = "Objective To determine whether the implementation of a national program to improve quality of care in geriatric rehabilitation (GR) in the Netherlands improves successful GR in terms of independence in activities of daily living (ADL), discharge destination, and length of stay. Design Prospective longitudinal study, comparing 2 consecutive cohorts: at the start of implementation (n = 386) and at 1 year after implementation (n = 357) of this program. Setting/Participants Included were 16 skilled nursing facilities, 743 patients (median age 80 years, interquartile range 72–85; 64.5{\%} females) indicated for GR and their health care professionals (elderly care physicians, physiotherapists, and nursing staff). Intervention National program to stimulate self-organizing capacity to develop integrated care to improve GR service delivery in 4 domains: alignment with patients’ (care) needs, care coordination, team cooperation, and quality of care. Measurements Data on patients’ characteristics, functional outcomes at admission and discharge, length of stay, and discharge destination were collected via an online questionnaire sent to health care professionals. The primary outcome measure was successful rehabilitation defined as independence in ADL (Barthel Index ≥15), discharge home, and a short length of stay (lowest 25{\%} per diagnostic group). Generalized estimating equation analysis was used to adjust for age, gender, and clustering effects in the total population and for the 2 largest diagnostic subgroups, traumatic injuries and stroke. Results In the total population, at 1 year postimplementation there was 12{\%} more ADL independence [odds ratio (OR) 1.59, 95{\%} confidence interval (CI) 1.00–2.54]. Although successful rehabilitation (independence in ADL, discharge home, short length of stay) was similar in the 2 cohorts, patients with traumatic injuries were more successful 1 year postimplementation (OR 1.61, 95{\%} CI 1.01–2.54). In stroke patients, successful rehabilitation was similar between the cohorts, but with more independence in ADL in the follow-up cohort (OR 1.99, 95{\%} CI 1.09–3.63). Conclusions This study shows that 1-year after the implementation of the Dutch national program to improve quality of care there was more independence in ADL at discharge, but the combined outcome of successful GR (independence in ADL, discharge home, short length of stay) was only significantly improved in patients with traumatic injuries.",
keywords = "discharge destination, Geriatric rehabilitation, independence in ADL, length of stay, quality of care, successful rehabilitation",
author = "Holstege, {Marije S.} and Caljouw, {Monique A.A.} and Zekveld, {Ineke G.} and {van Balen}, Romke and Jacobijn Gussekloo and Achterberg, {Wilco P.} and Holstege, {Marije S.} and {de Groot}, {Aafke J.} and Hertogh, {Cees M.P.M.} and {van Haastregt}, {Jolanda C.M.} and Schols, {Jos M.G.A.} and Schols, {Jos M.G.A.}",
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Holstege, MS, Caljouw, MAA, Zekveld, IG, van Balen, R, Gussekloo, J, Achterberg, WP, Holstege, MS, de Groot, AJ, Hertogh, CMPM, van Haastregt, JCM, Schols, JMGA & Schols, JMGA 2017, 'Successful Geriatric Rehabilitation: Effects on Patients’ Outcome of a National Program to Improve Quality of Care, the SINGER Study' Journal of the American Medical Directors Association, vol. 18, no. 5, pp. 383-387. https://doi.org/10.1016/j.jamda.2016.10.011

Successful Geriatric Rehabilitation : Effects on Patients’ Outcome of a National Program to Improve Quality of Care, the SINGER Study. / Holstege, Marije S.; Caljouw, Monique A.A.; Zekveld, Ineke G.; van Balen, Romke; Gussekloo, Jacobijn; Achterberg, Wilco P.; Holstege, Marije S.; de Groot, Aafke J.; Hertogh, Cees M.P.M.; van Haastregt, Jolanda C.M.; Schols, Jos M.G.A.; Schols, Jos M.G.A.

In: Journal of the American Medical Directors Association, Vol. 18, No. 5, 01.05.2017, p. 383-387.

Research output: Contribution to journalArticleAcademicpeer-review

TY - JOUR

T1 - Successful Geriatric Rehabilitation

T2 - Effects on Patients’ Outcome of a National Program to Improve Quality of Care, the SINGER Study

AU - Holstege, Marije S.

AU - Caljouw, Monique A.A.

AU - Zekveld, Ineke G.

AU - van Balen, Romke

AU - Gussekloo, Jacobijn

AU - Achterberg, Wilco P.

AU - Holstege, Marije S.

AU - de Groot, Aafke J.

AU - Hertogh, Cees M.P.M.

AU - van Haastregt, Jolanda C.M.

AU - Schols, Jos M.G.A.

AU - Schols, Jos M.G.A.

PY - 2017/5/1

Y1 - 2017/5/1

N2 - Objective To determine whether the implementation of a national program to improve quality of care in geriatric rehabilitation (GR) in the Netherlands improves successful GR in terms of independence in activities of daily living (ADL), discharge destination, and length of stay. Design Prospective longitudinal study, comparing 2 consecutive cohorts: at the start of implementation (n = 386) and at 1 year after implementation (n = 357) of this program. Setting/Participants Included were 16 skilled nursing facilities, 743 patients (median age 80 years, interquartile range 72–85; 64.5% females) indicated for GR and their health care professionals (elderly care physicians, physiotherapists, and nursing staff). Intervention National program to stimulate self-organizing capacity to develop integrated care to improve GR service delivery in 4 domains: alignment with patients’ (care) needs, care coordination, team cooperation, and quality of care. Measurements Data on patients’ characteristics, functional outcomes at admission and discharge, length of stay, and discharge destination were collected via an online questionnaire sent to health care professionals. The primary outcome measure was successful rehabilitation defined as independence in ADL (Barthel Index ≥15), discharge home, and a short length of stay (lowest 25% per diagnostic group). Generalized estimating equation analysis was used to adjust for age, gender, and clustering effects in the total population and for the 2 largest diagnostic subgroups, traumatic injuries and stroke. Results In the total population, at 1 year postimplementation there was 12% more ADL independence [odds ratio (OR) 1.59, 95% confidence interval (CI) 1.00–2.54]. Although successful rehabilitation (independence in ADL, discharge home, short length of stay) was similar in the 2 cohorts, patients with traumatic injuries were more successful 1 year postimplementation (OR 1.61, 95% CI 1.01–2.54). In stroke patients, successful rehabilitation was similar between the cohorts, but with more independence in ADL in the follow-up cohort (OR 1.99, 95% CI 1.09–3.63). Conclusions This study shows that 1-year after the implementation of the Dutch national program to improve quality of care there was more independence in ADL at discharge, but the combined outcome of successful GR (independence in ADL, discharge home, short length of stay) was only significantly improved in patients with traumatic injuries.

AB - Objective To determine whether the implementation of a national program to improve quality of care in geriatric rehabilitation (GR) in the Netherlands improves successful GR in terms of independence in activities of daily living (ADL), discharge destination, and length of stay. Design Prospective longitudinal study, comparing 2 consecutive cohorts: at the start of implementation (n = 386) and at 1 year after implementation (n = 357) of this program. Setting/Participants Included were 16 skilled nursing facilities, 743 patients (median age 80 years, interquartile range 72–85; 64.5% females) indicated for GR and their health care professionals (elderly care physicians, physiotherapists, and nursing staff). Intervention National program to stimulate self-organizing capacity to develop integrated care to improve GR service delivery in 4 domains: alignment with patients’ (care) needs, care coordination, team cooperation, and quality of care. Measurements Data on patients’ characteristics, functional outcomes at admission and discharge, length of stay, and discharge destination were collected via an online questionnaire sent to health care professionals. The primary outcome measure was successful rehabilitation defined as independence in ADL (Barthel Index ≥15), discharge home, and a short length of stay (lowest 25% per diagnostic group). Generalized estimating equation analysis was used to adjust for age, gender, and clustering effects in the total population and for the 2 largest diagnostic subgroups, traumatic injuries and stroke. Results In the total population, at 1 year postimplementation there was 12% more ADL independence [odds ratio (OR) 1.59, 95% confidence interval (CI) 1.00–2.54]. Although successful rehabilitation (independence in ADL, discharge home, short length of stay) was similar in the 2 cohorts, patients with traumatic injuries were more successful 1 year postimplementation (OR 1.61, 95% CI 1.01–2.54). In stroke patients, successful rehabilitation was similar between the cohorts, but with more independence in ADL in the follow-up cohort (OR 1.99, 95% CI 1.09–3.63). Conclusions This study shows that 1-year after the implementation of the Dutch national program to improve quality of care there was more independence in ADL at discharge, but the combined outcome of successful GR (independence in ADL, discharge home, short length of stay) was only significantly improved in patients with traumatic injuries.

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