Evaluation of patient-centered rehabilitation model targeting older persons with a hip fracture, including those with cognitive impairment

Katherine S Mcgilton,Nizar Mahomed,Steven Stewart,Gary Naglie,Cheryl Cott,John Flannery,Aileen M Davis,Susan Jaglal

doi:10.1186/1471-2318-13-136

Abstract

BackgroundThe purpose of this study was to evaluate outcomes for older persons post-hip fracture repair, including those with cognitive impairment (CI), following implementation of a novel model of care – the Patient-Centered Rehabilitation Model including persons with CI (PCRM-CI). The PCRM-CI is an interdisciplinary rehabilitation program that incorporates education for healthcare professionals (HCPs), including nurses, which is focused on geriatric care including management of dementia and delirium, support for HCPs from an Advanced Practice Nurse, and family support and education. Primary outcome measures were mobility gain from admission to discharge and whether or not patients returned home post-discharge.MethodsThe PCRM-CI intervention was evaluated using a quasi-experimental design, following implementation in two community hospital inpatient rehabilitation units. One hundred forty-nine patients aged 65 and older participated as patients in the usual care (76) or PCRM-CI intervention (73) groups. Patient mobility was assessed at admission and discharge by the Functional Independence Measure Motor Subscale (FIMM); the difference in mobility scores was defined as mobility gain. Patient discharge location was also captured to determine whether or not patients returned home from inpatient rehabilitation.ResultsNo difference in mobility gain was found between the usual care and PCRM-CI groups as measured by the FIMM. Patients in the intervention group were more likely to return home post-discharge than those in the usual care group (p = 0.02).ConclusionsResults of the PCRM-CI evaluation suggest that older adults with CI can successfully be rehabilitated post-hip fracture repair using this novel, interdisciplinary rehabilitation program.Trial registrationThis trial has been registered with the US National Institutes of Health (ID: NCT01566136)

Highlights

The purpose of this study was to evaluate outcomes for older persons post-hip fracture repair, including those with cognitive impairment (CI), following implementation of a novel model of care – the Patient-Centered Rehabilitation Model including persons with CI (PCRM-CI)
With the aging population and the increase in number of persons with CI, insufficient specialized geriatric rehabilitation beds are available for older persons post-hip fracture [13] but there are no plans to create more of these units
In order to accommodate patients post-hip fracture with CI in general MSK inpatient rehabilitation units, Healthcare professional (HCP) may be required to develop new competencies to care for this growing population

Summary

Introduction

The purpose of this study was to evaluate outcomes for older persons post-hip fracture repair, including those with cognitive impairment (CI), following implementation of a novel model of care – the Patient-Centered Rehabilitation Model including persons with CI (PCRM-CI). Recovery may be complicated by delirium and/or In recognition of this complexity, specialized programs have been developed to improve outcomes for older persons post-hip fracture. Evidence of positive functional gain, reduced length of stay, and fewer complications post-hip fracture in older persons with CI has emerged over the past 15 years from specialized geriatric rehabilitation units that admit patients with CI [8,9,10,11,12]. People with CI are often refused entry into general musculoskeletal (MSK) inpatient rehabilitation programs as staff believe they cannot be rehabilitated For those few patients post-hip fracture with CI transferred to general MSK inpatient rehabilitation units, the professional healthcare providers (HCPs) there often lack the necessary skills and knowledge about cognitive and behavioral strategies to provide adequate care for these complex patients [14,15]. In order to accommodate patients post-hip fracture with CI in general MSK inpatient rehabilitation units, HCPs may be required to develop new competencies to care for this growing population

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