Evaluation of restorative care vs usual care for older adults receiving an acute episode of home care

JAMA. 2002 Apr 24;287(16):2098-105. doi: 10.1001/jama.287.16.2098.

Abstract

Context: Illness and hospitalization often trigger functional decline among older persons. Home care services implemented for functional decline provide an opportunity to intervene to improve outcomes.

Objective: To compare functional status and the likelihood of remaining at home for persons receiving restorative care vs usual home care.

Design and setting: Intervention using prospective individual matching conducted between November 1, 1998, and April 30, 2000. Six offices of a home care agency in Connecticut were used. One branch office served as the restorative care unit and the other 5 served as usual care offices.

Participants: Patients receiving home care through the restorative care office who were 65 years or older; in receipt of Medicare-covered home care lasting at least 7 days; with absence of severe cognitive impairment; and not terminal, bedridden, or requiring total care were matched with patients from 1 of the usual care offices. The matching factors included age, sex, race, baseline self-care function, cognitive status, whether hospitalization preceded the home care episode, and date of the home care episode. Of the 712 eligible restorative care patients, 691 (97%) were matched with a usual care patient.

Intervention: Restorative care, provided by the home care agency nursing, therapy, and home health aide staff, was based on principles from geriatric medicine, nursing, rehabilitation, and goal attainment.

Main outcome measures: Remaining at home, functional status at completion of the home care episode, and duration and intensity of home care episode.

Results: Compared with usual care, and after adjusting for baseline characteristics and other factors, restorative care was associated with a greater likelihood of remaining at home (82% vs 71%; odds ratio [OR], 1.99; 95% confidence interval [CI], 1.47-2.69) and a reduced likelihood of visiting an emergency department (10% vs 20%; OR, 0.44; 95% CI, 0.32-0.61). Home care episodes were shorter (mean [SD], 24.8 [26.8] days vs 34.3 [44.2] days; S = -17 821; P<.001). Restorative care patients had better mean (SD) scores than usual care patients in self-care (11.0 [2.1] vs 10.7 [2.5]; P =.07 after adjustment), home management (9.5 [2.9] vs 9.2 [3.0]; P =.05 after adjustment), and mobility (3.3 [0.8] vs 3.2 [0.9]; P =.02 after adjustment).

Conclusions: This trial suggests that reorganizing the structure and goals of home care can enhance health outcomes of older patients without increasing health care utilization.

Publication types

  • Clinical Trial
  • Controlled Clinical Trial
  • Research Support, Non-U.S. Gov't
  • Research Support, U.S. Gov't, P.H.S.

MeSH terms

  • Activities of Daily Living
  • Aged
  • Emergency Medical Services
  • Episode of Care*
  • Geriatrics
  • Home Care Services*
  • Humans
  • Office Visits*
  • Outcome and Process Assessment, Health Care*
  • Prospective Studies
  • United States