Aim
Better@Home Subacute (B@H) is a multidisciplinary home-based rehabilitation program that commenced in 2021 at Austin Health, a tertiary metropolitan Melbourne hospital. We aimed to compare the B@H program in its first 12 months of operation to inpatient units.
Method
Retrospective study of patients admitted to B@H, and inpatient general medicine and geriatric evaluation and medicine (GEM) units between 15th September 2021 to 14th September 2022. We compared the difference of the average between cases (B@H) and controls (general medicine/GEM) of 28-day hospital readmission, 28-day mortality, allied health use and adverse events rates, imputed using nearest neighbour matching for diagnosis, age, sex and Charlson Comorbidity Index.
Results
There were 211 admissions to B@H over 12 months (median age [interquartile range (IQR)] 80 years [68 – 87], 52% female, median length of admission [IQR] 14 days [11 – 15], mean±standard deviation 3.3±1.0 different allied health members involved per person). The most common reasons to be admitted under B@H were musculoskeletal (37%) and neurological (35%). Patients admitted to B@H had fewer comorbidities than inpatient units (general medicine p=0.009, GEM p<0.001), more allied health involvement compared to general medicine (p<0.001) but less than GEM (p<0.001), and less adverse events per person compared to both general medicine and GEM (both p<0.001). There was no increase in 28-day mortality or 28-day hospital readmission for B@H patients compared to inpatient units.
Conclusion
This study supports an alternative to inpatient rehabilitation programs for selected patients. Compared to inpatient management, early discharge to community programs may be beneficial.