Consistent evaluation of treatment outcomes across subacute and community settings: experience of the Graduated...

OBJECTIVE; Although mounting evidence suggests that early supporting discharge has benefits for both patients and the health service, such programs pose unique challenges for rigorous assessment of treatment outcomes. The aim of this study was to describe assessment of clinical outcomes in the Graduated Discharge Program (GDP) across hospital and community settings.

The GDP involved substitution of community-based rehabilitation for the last week of inpatient care. A consensus group of hospital and community rehabilitation professionals chose the Timed Up and Go (TUAG) test as the primary clinical outcome that would be assessed across settings, with data stored in the community. We recorded the consistency of test performance across settings and readmission rates.

At hospital admission TUAG results were available for 82% of participants, compared to 94% at subacute discharge, 89% at end of GDP and 77% at end of community rehabilitation. Seat height during testing did not remain consistent across settings; however, significant improvements in TUAG were seen over time. There was no increase in readmission rate during the GDP. CONCLUSIONS; By involving members of the treating team in decisions about outcome assessment and data storage it was possible to reliably document clinical outcomes across multiple settings of care.