HEALTH OUTCOMES OF POST-HOSPITAL IN-HOME TEAM CARE - SECONDARY ANALYSIS OF A SWEDISH TRIAL

OBJECTIVE: To determine patient and treatment-related factors predicti ve of health outcomes. DESIGN: Secondary analysis of a randomized tria l with 6-month follow-up. After using bivariate and three-way analysis in the total sample to screen outcome predictors and interactions amo ng baseline variables, multivariate logistic regression was used to mo del outcomes. SETTING: A county general hospital in central Stockholm, and patients' homes nearby. PATIENTS: Hospital inpatients stable for discharge from acute care, having at least one chronic condition, and dependent in 1 to 5 Katz activities of daily life (ADLs) were included . Subjects (mean age = 81.1 years) were randomized to ''team'' (n = 15 0) or ''usual care'' (n = 99). INTERVENTIONS: Team patients were eligi ble for in-home primary care by an interdisciplinary team that include d a physician, physical therapist, and 24-hour nursing services and ge riatric consultation where necessary. ''Usual-care'' patients received standard district nurse-administered services at home upon hospital d ischarge. MEASUREMENTS: Demographic, functional status, and medical ch aracteristics were measured at randomization; Outcomes included surviv al and higher ADL, instrumental ADL (IADL), and outdoor ambulation sco res. MAIN RESULTS: Multiple medical, social, behavioral, and functiona l factors were associated with outcomes. Primary cardiac disease, numb er of prescription drugs, alcohol abstinence, and baseline mental stat us all impacted 6-month survival. Controlling for other factors, team care improved the likelihood of ambulation independent of personal ass istance at follow-up (P = .027), treating an estimated 10 patients per 1 benefiting. Further, rehabilitative in-home team care neutralized m ortality and functional risk factors (low number of baseline contacts and coresidence) apparent in usual care. CONCLUSIONS: Heterogeneous cl inical populations of older patients contain many prevalent characteri stics important to outcomes. Secondary analysis of trials including in teractions identifies treatable and untreatable risks, what program co mponents may be effective, and who benefits.