Description: This planning grant will facilitate the development of an intervention study aimed at improving subacute care rehabilitation outcomes and reducing health care costs among nursing home residents with co-morbid depression and need for rehabilitation. The intervention targets continuity of care and person- centered care by involving the resident, family and outside primary care physician. Further, the protocol has the potential to be adopted on a large scale within the US long-term care system. Abstract: Close to one and a half million elderly patients a year receive rehabilitation in a nursing home (NH), at a cost of nearly $10,000 per admission (CMS table 40, 1999), and the use of NHs for rehabilitation stays for such conditions as hip fracture, stroke and heart attack (Ml), among other less frequently occurring morbidities, is increasing (Wells et al., 2003). Clearly, improving discharge rates and shortening lengths of stay for persons with these disabling conditions are important goals in terms of both costs and patient quality of life. A frequently occurring co-morbidity accompanying these disabling conditions is depression. In fact, over one third of (NH) residents admitted under Medicare for rehabilitation have co-morbid depression (Boyle et al, 2004). In addition to its obvious toll on patient quality of life, depression leads to poorer functional outcomes in these patients by impeding compliance with and participation in treatment, including rehabilitation therapies. We propose to evaluate a 90-day intervention that applies successful depression care management models to the treatment of persons with disabling conditions resulting in the need for rehabilitation in the NH setting. This management strategy includes early and repeated depression screening with feedback to a care management team specializing in the management of co-morbid depression in functionally disabled older persons. The intervention will focus on new NH admissions admitted under Medicare for rehabilitation for the three most common admission diagnoses: hip fracture, stroke and heart attack (Ml), hereafter referred to as 'rehabilitation morbidity admissions' (RMAs). The intervention will be evaluated using a randomized controlled trial design. The primary aims of this study (which we will refer to as the """"""""future trial"""""""") will be to compare 6-month outcomes between intervention and control groups with regard to clinical and functional status. Secondary aims will be to evaluate the costs of the intervention in terms of staff time use and Medicare expenditures. In the present application, we are requesting support for the planning and development of the future trial. The planning process will involve the analysis of existing data, the conduct of a preliminary study, and the development of detailed research protocols and a manual of procedures.
| Quinn, Charlene C; Port, Cynthia L; Zimmerman, Sheryl et al. (2008) Short-stay nursing home rehabilitation patients: transitional care problems pose research challenges. J Am Geriatr Soc 56:1940-5 |
