Abstract Objective: To describe changes in the health service delivery process experienced by professionals, patients and informal caregivers during implementation of a national programme to improve quality of care of geriatric rehabilitation by improving integration of health service delivery processes. Study setting: Sixteen skilled nursing facilities. Study design: Prospective study, comparing three consecutive cohorts. Data collection: Professionals (elderly care physicians, physiotherapists and nursing staff) rated four domains of health service delivery at admission and at discharge of 1075 patients. In addition, these patients [median age 79 (Interquartile range 71–85) years, 63% females] and their informal caregivers rated their experiences on these domains 4 weeks after discharge. Principal findings: During the three consecutive cohorts, professionals reported improvement on the domain team cooperation, including assessment for intensive treatment and information transfer among professionals. Fewer improvements were reported within the domains alignment with patients’ needs, care coordination and care quality. Between the cohorts, according to patients (n = 521) and informal caregivers (n = 319) there were no changes in the four domains of health service delivery. Conclusion: This national programme resulted in small improvements in team cooperation as reported by the professionals. No effects were found on patients’ and informal caregivers’ perceptions of health service delivery.
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PurposeInternationally, many differences are observed regarding the practice of geriatric rehabilitation for older people living at home. To improve international collaboration and research on this topic, we aimed to reach a consensus on terminology, organisational aspects, and outcome domains to focus on.MethodsWe conducted a three-round online Delphi study among 60 (Home-based) geriatric rehabilitation experts from 14 countries. In the first round, we collected diverse perspectives and input through statements and questions. In the subsequent rounds, participants rated statements on a 5-point Likert scale. Each statement could be accompanied by written feedback. After each round, results were presented anonymously to the participants, and statements on which no consensus was reached were rephrased. Consensus was defined as 70% or more participants (fully) agreeing with a statement.ResultsSixty, 52, and 46 experts completed rounds 1, 2 and 3, respectively. After two rounds, we reached a consensus on ten statements and on the remaining four in the last round. A consensus was reached on the terminology used (i.e., home-based geriatric rehabilitation) and on several organisational aspects (e.g., essential aspects to consider for starting home-based geriatric rehabilitation and the importance of a knowledgeable case manager). Lastly, experts agreed that participation and activity are the most important outcome domains to focus on.ConclusionsThrough an international Delphi study, we reached consensus on various important aspects of home-based geriatric rehabilitation. These outcomes provide a basis for further development of this emerging field.
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Key summary points Aim To reach consensus on terminology, organisational aspects, and outcome domains of geriatric rehabilitation for older people living at home. Findings In three rounds, an international panel reached a consensus regarding the term “home-based geriatric rehabilitation” to distinguish it from inpatient rehabilitation. The panel also identifed key organisational aspects essential for its implementation and concluded that participation and activity are the primary outcome domains to focus on. Message The results of this International Delphi shows consensus of experts on various topics in home-based GR, which is important to further develop international collaboration, development and research on this topic. Abstract Purpose Internationally, many diferences are observed regarding the practice of geriatric rehabilitation for older people living at home. To improve international collaboration and research on this topic, we aimed to reach a consensus on terminology, organisational aspects, and outcome domains to focus on. Methods We conducted a three-round online Delphi study among 60 (Home-based) geriatric rehabilitation experts from 14 countries. In the frst round, we collected diverse perspectives and input through statements and questions. In the subsequent rounds, participants rated statements on a 5-point Likert scale. Each statement could be accompanied by written feedback. After each round, results were presented anonymously to the participants, and statements on which no consensus was reached were rephrased. Consensus was defned as 70% or more participants (fully) agreeing with a statement. Results Sixty, 52, and 46 experts completed rounds 1, 2 and 3, respectively. After two rounds, we reached a consensus on ten statements and on the remaining four in the last round. A consensus was reached on the terminology used (i.e., home-based geriatric rehabilitation) and on several organisational aspects (e.g., essential aspects to consider for starting home-based geriatric rehabilitation and the importance of a knowledgeable case manager). Lastly, experts agreed that participation and activity are the most important outcome domains to focus on. Conclusions Through an international Delphi study, we reached consensus on various important aspects of home-based geriatric rehabilitation. These outcomes provide a basis for further development of this emerging feld.
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