Improving Outcomes: Extending the Continuum of Care with Sub-Acute Care

2.50
Hdl Handle:
http://hdl.handle.net/10755/150443
Type:
Presentation
Title:
Improving Outcomes: Extending the Continuum of Care with Sub-Acute Care
Abstract:
Improving Outcomes: Extending the Continuum of Care with Sub-Acute Care
Conference Sponsor:Sigma Theta Tau International
Conference Year:2001
Conference Date:November 10 - 14, 2001
Author:Goolsby, Mary
P.I. Institution Name:University Health Care System
Until recently, patients who met subacute DRG classification and received care in one East Georgia city received that care on an acute-care hospital unit or in a free-standing long-term care or rehabilitation center. This was believed to be an ineffective utilization of resources and a fragmentation of the continuity of care. A large health care system, anchored by a 612-acute care bed hospital, submitted a Certificate of Need proposal to the state’s health planning agency, to develop an in-house 20-bed subacute unit. The resulting subacute unit, or Transitional Care Unit (TCU) became part of a patient-centered alternative health care model for the provision of a geriatric continuum of care. A comprehensive research program was developed to measure the outcomes and effectiveness of the project. This paper describes the care provided on the TCU, as well as the processes through which outcome measures were selected and measured, and the outcomes identified. The primary goals for the care management model used in the resulting continuum of care were to promote older adults’ quality of life through the provision and coordination of health care and support services necessary to enable older adults to maintain independence and to live in their homes to the extent possible. The development of the TCU was seen as a means through which to improve the cost-effectiveness and continuity of geriatric care, while adding formal linkages through a case management model and promoting the least restrictive level of care possible. It was hypothesized that the program would result in reduced costs associated with the care of elderly patients while improving outcomes. Outcome measurement project included length of stay and cost of subacute care, as well as rate of readmission and resources required following completion of subacute care. Surveys were performed soon after patients were admitted to the TCU and again 2 months following discharge from subacute care. The survey included items to measure skin integrity, pain ratings, and quality of life ratings, as well as standardized instruments to measure mental health (Center for Epidemiology Depression Scale and subscales of the SF-36) and functional status (Barthel Index and subscales of the SF-36). The same data had been collected on patients receiving subacute care on acute care units during the year preceding the establishment of the TCU. This allowed for comparisons to be made between outcomes associated with care associated with admission to the TCU and care provided elsewhere. The outcomes supported the importance of the TCU in improving resource utilization while maintaining or optimizing patient-related outcomes. The cost of subacute care delivered on the TCU was significantly lower than that previously provided on acute care units. Although the TCU patients were, in general, older than those who had been previously classified as subacute patients, they are more likely to be discharged home from the TCU (as opposed to the comparison group who more frequently went to other rehabilitation or long-term care). They expressed greater satisfaction with their care. The TCU group had statistically significantly higher scores on quality of life, skin integrity, depression, satisfaction, and the mental health and physical function scores of the SF-36. The other outcomes were either equivalent to those achieved through care based on an acute care unit or improved at a level that was not statistically significant. The outcome measurement project indicates that the objectives of the TCU are being met. The outcomes clearly identify that the older adults served through this unit have achieved a higher quality of life. The outcomes also identify that the case management approach has successfully facilitated the independence of the population served and promoted appropriate coordination of post-discharge health care and support services.
Repository Posting Date:
26-Oct-2011
Date of Publication:
10-Nov-2001
Sponsors:
Sigma Theta Tau International

Full metadata record

DC FieldValue Language
dc.typePresentationen_GB
dc.titleImproving Outcomes: Extending the Continuum of Care with Sub-Acute Careen_GB
dc.identifier.urihttp://hdl.handle.net/10755/150443-
dc.description.abstract<table><tr><td colspan="2" class="item-title">Improving Outcomes: Extending the Continuum of Care with Sub-Acute Care</td></tr><tr class="item-sponsor"><td class="label">Conference Sponsor:</td><td class="value">Sigma Theta Tau International</td></tr><tr class="item-year"><td class="label">Conference Year:</td><td class="value">2001</td></tr><tr class="item-conference-date"><td class="label">Conference Date:</td><td class="value">November 10 - 14, 2001</td></tr><tr class="item-author"><td class="label">Author:</td><td class="value">Goolsby, Mary</td></tr><tr class="item-institute"><td class="label">P.I. Institution Name:</td><td class="value">University Health Care System</td></tr><tr class="item-email"><td class="label">Email:</td><td class="value">moolsby@uh.org</td></tr><tr><td colspan="2" class="item-abstract">Until recently, patients who met subacute DRG classification and received care in one East Georgia city received that care on an acute-care hospital unit or in a free-standing long-term care or rehabilitation center. This was believed to be an ineffective utilization of resources and a fragmentation of the continuity of care. A large health care system, anchored by a 612-acute care bed hospital, submitted a Certificate of Need proposal to the state&rsquo;s health planning agency, to develop an in-house 20-bed subacute unit. The resulting subacute unit, or Transitional Care Unit (TCU) became part of a patient-centered alternative health care model for the provision of a geriatric continuum of care. A comprehensive research program was developed to measure the outcomes and effectiveness of the project. This paper describes the care provided on the TCU, as well as the processes through which outcome measures were selected and measured, and the outcomes identified. The primary goals for the care management model used in the resulting continuum of care were to promote older adults&rsquo; quality of life through the provision and coordination of health care and support services necessary to enable older adults to maintain independence and to live in their homes to the extent possible. The development of the TCU was seen as a means through which to improve the cost-effectiveness and continuity of geriatric care, while adding formal linkages through a case management model and promoting the least restrictive level of care possible. It was hypothesized that the program would result in reduced costs associated with the care of elderly patients while improving outcomes. Outcome measurement project included length of stay and cost of subacute care, as well as rate of readmission and resources required following completion of subacute care. Surveys were performed soon after patients were admitted to the TCU and again 2 months following discharge from subacute care. The survey included items to measure skin integrity, pain ratings, and quality of life ratings, as well as standardized instruments to measure mental health (Center for Epidemiology Depression Scale and subscales of the SF-36) and functional status (Barthel Index and subscales of the SF-36). The same data had been collected on patients receiving subacute care on acute care units during the year preceding the establishment of the TCU. This allowed for comparisons to be made between outcomes associated with care associated with admission to the TCU and care provided elsewhere. The outcomes supported the importance of the TCU in improving resource utilization while maintaining or optimizing patient-related outcomes. The cost of subacute care delivered on the TCU was significantly lower than that previously provided on acute care units. Although the TCU patients were, in general, older than those who had been previously classified as subacute patients, they are more likely to be discharged home from the TCU (as opposed to the comparison group who more frequently went to other rehabilitation or long-term care). They expressed greater satisfaction with their care. The TCU group had statistically significantly higher scores on quality of life, skin integrity, depression, satisfaction, and the mental health and physical function scores of the SF-36. The other outcomes were either equivalent to those achieved through care based on an acute care unit or improved at a level that was not statistically significant. The outcome measurement project indicates that the objectives of the TCU are being met. The outcomes clearly identify that the older adults served through this unit have achieved a higher quality of life. The outcomes also identify that the case management approach has successfully facilitated the independence of the population served and promoted appropriate coordination of post-discharge health care and support services.</td></tr></table>en_GB
dc.date.available2011-10-26T10:24:37Z-
dc.date.issued2001-11-10en_GB
dc.date.accessioned2011-10-26T10:24:37Z-
dc.description.sponsorshipSigma Theta Tau Internationalen_GB
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