Clinical Interventions in Aging (Oct 2023)
Short-Term, Community-Based, Slow-Stream Rehabilitation Program for Older Adults Transitioning from Hospital to Home: A Mixed Methods Program Evaluation
Abstract
Vanina Dal Bello-Haas,1 Sharon Kaasalainen,2 Melody Maximos,3 Olivia Virag,4 Sirirat Seng-iad,5 Alyssa Te,6 Matthew Bui7 1School of Rehabilitation Science, McMaster University, Hamilton, Ontario, Canada; 2School of Nursing, McMaster University, Hamilton, Ontario, Canada; 3CBI Health, Nepean, Ontario, Canada; 4Department of Family Medicine, David Braley Health Sciences Centre, Hamilton, Ontario, Canada; 5Sirindhorn School of Prosthetics and Orthotics, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand; 6Credit Valley Hospital, Trillium Health Partners, Mississauga, Ontario, Canada; 7McMaster Children’s Hospital, Hamilton Health Sciences, Hamilton, Ontario, CanadaCorrespondence: Vanina Dal Bello-Haas, Email [email protected]: Shortened hospital stays have shifted the burden of care for older adults to community, informal (ie, family, caregiver) and formal post-acute care and services, highlighting the need for effective post-hospital stay services and programs. As there is a dearth of information related to community-based, slow-stream rehabilitation program models for older adults transitioning from hospital to home in the Canadian context, the paper describes a mixed methods evaluation of such a program.Materials and Methods: A mixed methods program evaluation, with process- and outcome-related elements, included 1) review and analysis of program documents; 2) observations to examine fidelity. Observation data were coded and summarized using descriptive statistics. Coded information and data were compared to document review data; 3) quantitative assessment of pre-post changes in physical, social, and psychological outcome measure and instrument scores using descriptive statistics, paired t-tests and confidence intervals (p = 0.05); and 4) exploration of acceptability through interviews and focus groups with 41 of the older adult participants and 17 family caregivers. Thematic analysis was used to examine focus group and interview transcripts.Results: Observational data indicated alignment with the program document information overall. Statistically and clinically significant positive trends in improvement for physical outcome measure scores were observed (6-minute Walk Test, Life Space Assessment, Short Physical Performance Battery, Rapid Assessment of Physical Activity). Participants and family caregivers identified several positives and benefits of the program, ie, improvement in physical, social and mental well-being, decreased caregiver burden; and areas for improvement ie, need for more information about the program prior to enrollment and individualization, several of which aligned with the observation and quantitative data.Discussion/Conclusion: This mixed methods program evaluation provided a detailed description of a community-based, slow-stream rehabilitation program for older adults who are transitioning to home post-hospital stay and its participants. Evidence of program fidelity, acceptability, and positive trends in improvement in physical outcome measure scores were found. Information about program strengths and areas for improvement can be used by stakeholders to inform program refinement and enhancement.Keywords: program evaluation, mixed methods, community-based program, older adults, hospital-to-home transition, slow-stream rehabilitation
