AIMS: To investigate patient level characteristics associated with successful rehabilitation in a home-based inpatient bed substitution model of care (Better at Home).
METHODS: Retrospective cohort study of patients aged ≥18 years admitted to Better at Home between 01 January 2021 to 30 March 2021. The primary outcome (‘successful rehabilitation’) was a composite score (out of 3) of: (1) patient remaining at home at discharge, (2) no readmissions within 7 days of discharge, and (3) improvement in FIM score. Patients were dichotomised into those scoring 0-2 and 3. Characteristics of each group were compared. Secondary outcomes included the rates of pressure injuries, falls, and transfers to ED.
RESULTS: Of the 175 patients included, 70 (40%) scored 0-2 and 105 (60%) scored 3. There were significant differences between the groups in Charlson’s Comorbidity Index (7.5 vs 6.7, p=0.05), number of admission medications (11.1 vs 9.5, p=0.02), and having a MyAgedCare package (38.5% vs 17.1%, p<0.01). There were no statistically significant differences between the groups in age, sex, nutritional status, living arrangements, cognitive impairment, IDC presence, or with routine screening tools (FRASS, BRADEN, MUST).
A MyAgedCare package and lower admission FIM were associated with increased falls. A lower BMI was associated with increased transfers to ED and a higher MUST with readmission.
CONCLUSION: A higher number of comorbidities, medications, and presence of formal supports were associated with poorer outcomes in the Better at Home Program. Larger prospective studies are needed to identify targeted interventions for those recognised at risk of poorer outcomes.