Evaluation of the effectiveness of Leek Moorlands Community Hospital Rehabilitation Unit, Staffordshire, UK

摘要

Introduction: The utilisation of Intermediate Care and Rehabilitation Units has been increasing due to a rise of the ageing population and a preference to treat more patients in the community rather than Acute hospitals. However, to ensure optimal use of resources it is important to investigate whether such Units are clinically effective. We recently evaluated the effectiveness of the Intermediate Care and Rehabilitation programme in our department in Leek Moorlands Community Hospital, North Staffordshire, UK. Methods: We retrospectively analysed all consecutive patients admitted in a six months period (1st November 2009 to 30th April 2010). Our primary outcome measure of effectiveness was the change in patients' functional ability between admission and discharge in terms of their Barthel scores. Secondly, we sought to identify possible determinants of outcome by investigating the relationship between change in Barthel scores and a variety of demographic and clinical variables (age, length of in-patient stay, morbidity burden, and initial disability level). The Wilcoxon signed rank test was used to assess the difference between Barthel scores. The relationship between the change in Barthel score and other variables was tested using Spearman's rank correlation coefficient. Results: The total number of patients was180. 35 patients were excluded from complete analysis because of missing or incomplete case-notes (31) or were still in hospital (4). For the patients who had complete data and could be analysed, there was a significant increase in Barthel score during admission (median difference 4, p<0.0001). There was no statistically significant correlation between the change in Barthel score and any other variables. 77% of patients were able to return home and only 23% had to be discharged to a Residential or Nursing home. Conclusions: Patients' functional abilities improved significantly during admission to the rehabilitation Unit and the vast majority returned home. Benefit was observed irrespective of age, initial level of dependence, medical complexity, and length of in-patient stay. This emphasizes the importance of providing access to rehabilitation services for patients of all age groups and initial disability level.