Evaluating Siebens Domain Management Model for Inpatient Rehabilitation to Increase Functional Independence and Discharge Rate to Home in Geriatric Patients

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Abstract

Abstract Objective To evaluate the Siebens Domain Management Model (SDMM) for geriatric inpatient rehabilitation (IR) to increase functional independence and dispositions to home. Design Before and after study. Setting IR facility. Participants During 2010 (preintervention), 429 patients aged ≥75 years who were on average admitted to IR 8.2 days postacute care, and during 2012 (postintervention), 524 patients aged ≥75 years who were on average admitted to IR 5.5 days postacute care. Case-mix group (CMG) comorbidity tier severity, preadmission living setting, and living support were similar in both groups. Intervention The SDMM involving weekly adjustments of IR care focused on potential barriers to discharge home. Main Outcome Measures FIM efficiency, length of stay (LOS), and disposition rates to community/home, acute care, and long-term care (LTC) to compare pre-/postintervention facility data and comparison of facility to national CMG-adjusted data from the Uniform Data System for Medical Rehabilitation for both years (2010/2012). Results Pre-/postintervention group admission FIM scores were similar (t=2.96, P<.003), but the preintervention group had on average 2.6 days greater LOS during IR and greater time to onset of IR (8.2 vs 5.5d) from acute care. Preintervention FIM efficiency was 2.1, whereas postintervention FIM efficiency was 2.76, a significant difference (t=4.1, P<.0001). There were significantly more discharges to the community in the postintervention group (74.4%) than the preintervention group (58.5%, χ<sup>2</sup>=26.2, P<.0001). There were significantly fewer patients discharged to LTC in the postintervention group (χ<sup>2</sup>=30.47, P<.0001). The preintervention group did not significantly differ from the 2010 national data, but the postintervention group significantly differed from the 2012 national data for both greater FIM efficiency (t=-5.5, P<.0001) and greater discharge to community (χ<sup>2</sup>=34, P<.0001). LOS decreased by 2.6 days in the postintervention group compared with the preintervention group, whereas LOS decreased by only 0.6 days nationally from 2010 to 2012, a significant difference with postintervention LOS lower than the national data (t=31.1, P<.0001). Conclusions Use of the SDMM during IR in geriatric patients is associated with increased functional independence and discharges to home/community and reduced institutionalization.

Original languageEnglish (US)
Article number56148
Pages (from-to)1310-1318
Number of pages9
JournalArchives of Physical Medicine and Rehabilitation
Volume96
Issue number7
DOIs
StatePublished - Jul 1 2015

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Geriatrics
Inpatients
Rehabilitation
Length of Stay
Subacute Care
Diagnosis-Related Groups
Institutionalization
Long-Term Care
Home Care Services
Information Systems
Comorbidity
Outcome Assessment (Health Care)

Keywords

  • Case management
  • Clinical conference [publication type]
  • Geriatrics
  • Institutionalization
  • Outcome assessment (healthcare)
  • Patient discharge
  • Rehabilitation

ASJC Scopus subject areas

  • Rehabilitation
  • Physical Therapy, Sports Therapy and Rehabilitation

Cite this

@article{f09d69bc733442f2894039168b130b2e,
title = "Evaluating Siebens Domain Management Model for Inpatient Rehabilitation to Increase Functional Independence and Discharge Rate to Home in Geriatric Patients",
abstract = "Abstract Objective To evaluate the Siebens Domain Management Model (SDMM) for geriatric inpatient rehabilitation (IR) to increase functional independence and dispositions to home. Design Before and after study. Setting IR facility. Participants During 2010 (preintervention), 429 patients aged ≥75 years who were on average admitted to IR 8.2 days postacute care, and during 2012 (postintervention), 524 patients aged ≥75 years who were on average admitted to IR 5.5 days postacute care. Case-mix group (CMG) comorbidity tier severity, preadmission living setting, and living support were similar in both groups. Intervention The SDMM involving weekly adjustments of IR care focused on potential barriers to discharge home. Main Outcome Measures FIM efficiency, length of stay (LOS), and disposition rates to community/home, acute care, and long-term care (LTC) to compare pre-/postintervention facility data and comparison of facility to national CMG-adjusted data from the Uniform Data System for Medical Rehabilitation for both years (2010/2012). Results Pre-/postintervention group admission FIM scores were similar (t=2.96, P<.003), but the preintervention group had on average 2.6 days greater LOS during IR and greater time to onset of IR (8.2 vs 5.5d) from acute care. Preintervention FIM efficiency was 2.1, whereas postintervention FIM efficiency was 2.76, a significant difference (t=4.1, P<.0001). There were significantly more discharges to the community in the postintervention group (74.4{\%}) than the preintervention group (58.5{\%}, χ2=26.2, P<.0001). There were significantly fewer patients discharged to LTC in the postintervention group (χ2=30.47, P<.0001). The preintervention group did not significantly differ from the 2010 national data, but the postintervention group significantly differed from the 2012 national data for both greater FIM efficiency (t=-5.5, P<.0001) and greater discharge to community (χ2=34, P<.0001). LOS decreased by 2.6 days in the postintervention group compared with the preintervention group, whereas LOS decreased by only 0.6 days nationally from 2010 to 2012, a significant difference with postintervention LOS lower than the national data (t=31.1, P<.0001). Conclusions Use of the SDMM during IR in geriatric patients is associated with increased functional independence and discharges to home/community and reduced institutionalization.",
keywords = "Case management, Clinical conference [publication type], Geriatrics, Institutionalization, Outcome assessment (healthcare), Patient discharge, Rehabilitation",
author = "David Kushner and Peters, {Kenneth M.} and Johnson-Greene, {Douglas E}",
year = "2015",
month = "7",
day = "1",
doi = "10.1016/j.apmr.2015.03.011",
language = "English (US)",
volume = "96",
pages = "1310--1318",
journal = "Archives of Physical Medicine and Rehabilitation",
issn = "0003-9993",
publisher = "W.B. Saunders Ltd",
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TY - JOUR

T1 - Evaluating Siebens Domain Management Model for Inpatient Rehabilitation to Increase Functional Independence and Discharge Rate to Home in Geriatric Patients

AU - Kushner, David

AU - Peters, Kenneth M.

AU - Johnson-Greene, Douglas E

PY - 2015/7/1

Y1 - 2015/7/1

N2 - Abstract Objective To evaluate the Siebens Domain Management Model (SDMM) for geriatric inpatient rehabilitation (IR) to increase functional independence and dispositions to home. Design Before and after study. Setting IR facility. Participants During 2010 (preintervention), 429 patients aged ≥75 years who were on average admitted to IR 8.2 days postacute care, and during 2012 (postintervention), 524 patients aged ≥75 years who were on average admitted to IR 5.5 days postacute care. Case-mix group (CMG) comorbidity tier severity, preadmission living setting, and living support were similar in both groups. Intervention The SDMM involving weekly adjustments of IR care focused on potential barriers to discharge home. Main Outcome Measures FIM efficiency, length of stay (LOS), and disposition rates to community/home, acute care, and long-term care (LTC) to compare pre-/postintervention facility data and comparison of facility to national CMG-adjusted data from the Uniform Data System for Medical Rehabilitation for both years (2010/2012). Results Pre-/postintervention group admission FIM scores were similar (t=2.96, P<.003), but the preintervention group had on average 2.6 days greater LOS during IR and greater time to onset of IR (8.2 vs 5.5d) from acute care. Preintervention FIM efficiency was 2.1, whereas postintervention FIM efficiency was 2.76, a significant difference (t=4.1, P<.0001). There were significantly more discharges to the community in the postintervention group (74.4%) than the preintervention group (58.5%, χ2=26.2, P<.0001). There were significantly fewer patients discharged to LTC in the postintervention group (χ2=30.47, P<.0001). The preintervention group did not significantly differ from the 2010 national data, but the postintervention group significantly differed from the 2012 national data for both greater FIM efficiency (t=-5.5, P<.0001) and greater discharge to community (χ2=34, P<.0001). LOS decreased by 2.6 days in the postintervention group compared with the preintervention group, whereas LOS decreased by only 0.6 days nationally from 2010 to 2012, a significant difference with postintervention LOS lower than the national data (t=31.1, P<.0001). Conclusions Use of the SDMM during IR in geriatric patients is associated with increased functional independence and discharges to home/community and reduced institutionalization.

AB - Abstract Objective To evaluate the Siebens Domain Management Model (SDMM) for geriatric inpatient rehabilitation (IR) to increase functional independence and dispositions to home. Design Before and after study. Setting IR facility. Participants During 2010 (preintervention), 429 patients aged ≥75 years who were on average admitted to IR 8.2 days postacute care, and during 2012 (postintervention), 524 patients aged ≥75 years who were on average admitted to IR 5.5 days postacute care. Case-mix group (CMG) comorbidity tier severity, preadmission living setting, and living support were similar in both groups. Intervention The SDMM involving weekly adjustments of IR care focused on potential barriers to discharge home. Main Outcome Measures FIM efficiency, length of stay (LOS), and disposition rates to community/home, acute care, and long-term care (LTC) to compare pre-/postintervention facility data and comparison of facility to national CMG-adjusted data from the Uniform Data System for Medical Rehabilitation for both years (2010/2012). Results Pre-/postintervention group admission FIM scores were similar (t=2.96, P<.003), but the preintervention group had on average 2.6 days greater LOS during IR and greater time to onset of IR (8.2 vs 5.5d) from acute care. Preintervention FIM efficiency was 2.1, whereas postintervention FIM efficiency was 2.76, a significant difference (t=4.1, P<.0001). There were significantly more discharges to the community in the postintervention group (74.4%) than the preintervention group (58.5%, χ2=26.2, P<.0001). There were significantly fewer patients discharged to LTC in the postintervention group (χ2=30.47, P<.0001). The preintervention group did not significantly differ from the 2010 national data, but the postintervention group significantly differed from the 2012 national data for both greater FIM efficiency (t=-5.5, P<.0001) and greater discharge to community (χ2=34, P<.0001). LOS decreased by 2.6 days in the postintervention group compared with the preintervention group, whereas LOS decreased by only 0.6 days nationally from 2010 to 2012, a significant difference with postintervention LOS lower than the national data (t=31.1, P<.0001). Conclusions Use of the SDMM during IR in geriatric patients is associated with increased functional independence and discharges to home/community and reduced institutionalization.

KW - Case management

KW - Clinical conference [publication type]

KW - Geriatrics

KW - Institutionalization

KW - Outcome assessment (healthcare)

KW - Patient discharge

KW - Rehabilitation

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U2 - 10.1016/j.apmr.2015.03.011

DO - 10.1016/j.apmr.2015.03.011

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JO - Archives of Physical Medicine and Rehabilitation

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