TY - JOUR
T1 - Occupational Therapy Predischarge Home Visits in Acute Hospital Care
T2 - A Randomized Trial
AU - Clemson, Lindy
AU - Lannin, Natasha A.
AU - Wales, Kylie
AU - Salkeld, Glenn
AU - Rubenstein, Laurence
AU - Gitlin, Laura
AU - Barris, Sarah
AU - Mackenzie, Lynette
AU - Cameron, Ian D.
PY - 2016/10/1
Y1 - 2016/10/1
N2 - Objectives: To determine whether an enhanced occupational therapy discharge planning intervention that involved pre- and postdischarge home visits, goal setting, and follow-up (the HOME program) would be superior to a usual care intervention in which an occupational therapy in-hospital consultation for planning and supporting discharge to home is provided to individuals receiving acute care. Design: Randomized controlled trial. Setting: Acute and medical wards. Participants: Individuals aged 70 and older (N = 400). Measurements: Primary outcomes: activities daily living (ADLs; Nottingham Extended Activities of Daily Living) and participation in life roles and activities (Late Life Disability Index (LLDI)). Results: Occupational therapist recommendations differed significantly between groups (P <.001) (HOME n = 892 recommendations; control n = 329 recommendations). There was no difference between groups in ADLs (Nottingham Extended Activities of Daily Living scale (NEADL): β = −0.17, 95% confidence interval (CI) = −0.99–0.66) or participation (LLDI—Frequency: β = −0.23, 95% CI = −2.05–1.59; LLDI—Limitation: β = −0.14, 95% CI = −2.86–2.58). Both groups maintained prehospital functional status at 90 days, and there was no difference between groups in the number of people with unplanned readmissions (HOME 23.5%, n = 43; control 21.9%, n = 37). When groups were combined, being male (P =.03) or having lower perceived participation because of physical problems (P =.04) resulted in higher risk of unplanned readmissions. Conclusion: HOME discharge planning, which had a strong emphasis on task modification, well-being, and prevention strategies, implemented twice as many occupational therapy recommendations as the in-hospital only consultation, which had a greater emphasis on equipment provision, but HOME did not demonstrate greater benefit in global measures of ADLs or participation in life tasks than in-hospital consultation alone. It is not recommended that home visits be conducted routinely as part of discharge planning for acutely hospitalized medical patients. Further work should develop guidelines for quality in-hospital consultation.
AB - Objectives: To determine whether an enhanced occupational therapy discharge planning intervention that involved pre- and postdischarge home visits, goal setting, and follow-up (the HOME program) would be superior to a usual care intervention in which an occupational therapy in-hospital consultation for planning and supporting discharge to home is provided to individuals receiving acute care. Design: Randomized controlled trial. Setting: Acute and medical wards. Participants: Individuals aged 70 and older (N = 400). Measurements: Primary outcomes: activities daily living (ADLs; Nottingham Extended Activities of Daily Living) and participation in life roles and activities (Late Life Disability Index (LLDI)). Results: Occupational therapist recommendations differed significantly between groups (P <.001) (HOME n = 892 recommendations; control n = 329 recommendations). There was no difference between groups in ADLs (Nottingham Extended Activities of Daily Living scale (NEADL): β = −0.17, 95% confidence interval (CI) = −0.99–0.66) or participation (LLDI—Frequency: β = −0.23, 95% CI = −2.05–1.59; LLDI—Limitation: β = −0.14, 95% CI = −2.86–2.58). Both groups maintained prehospital functional status at 90 days, and there was no difference between groups in the number of people with unplanned readmissions (HOME 23.5%, n = 43; control 21.9%, n = 37). When groups were combined, being male (P =.03) or having lower perceived participation because of physical problems (P =.04) resulted in higher risk of unplanned readmissions. Conclusion: HOME discharge planning, which had a strong emphasis on task modification, well-being, and prevention strategies, implemented twice as many occupational therapy recommendations as the in-hospital only consultation, which had a greater emphasis on equipment provision, but HOME did not demonstrate greater benefit in global measures of ADLs or participation in life tasks than in-hospital consultation alone. It is not recommended that home visits be conducted routinely as part of discharge planning for acutely hospitalized medical patients. Further work should develop guidelines for quality in-hospital consultation.
KW - discharge planning
KW - home visit
KW - occupational therapy
UR - http://www.scopus.com/inward/record.url?scp=84988014594&partnerID=8YFLogxK
U2 - 10.1111/jgs.14287
DO - 10.1111/jgs.14287
M3 - Article
C2 - 27603152
AN - SCOPUS:84988014594
SN - 0002-8614
VL - 64
SP - 2019
EP - 2026
JO - Journal of the American Geriatrics Society
JF - Journal of the American Geriatrics Society
IS - 10
ER -