Box 1.
Facilitators and Barriers during the national incentive according to the national process managers
Box 2.
Main goals of development of integrated care within the skilled nursing facilities in the four domains of geriatric rehabilitation service delivery
Figure 1.
Flowchart of patient recruitment and follow-up in the 16 skilled nursing facility. Analysed data include data rated by professional caregivers at admission and discharge, and response at 4 weeks’ follow-up, of patients and their informal caregivers.
Table 1.
Alignment with patients’ (care) needs, do professionals give what patients need? According to professionals (elderly care physicians and physiotherapists), patients and informal caregivers in percentage good and excellent. Selection of patients with completed professional data at baseline who had not died and were not readmitted to hospital during their rehabilitation stay (n = 1018)
ECP, Elderly care physician; PT, physiotherapist; P, patient; IC, informal caregiver. Values are numbers (% good and excellent) unless indicated otherwise. P for trend values were calculated with the Kruskal–Wallis test.
Professional rating N total: C1: n = 317; C2: n = 373; C3: n = 328.
Patient rating N total: C1:158; C2:193; C3:170.
Informal caregiver rating N total: C1:94; C2:121; C3:104.
*Rated at discharge from skilled nursing facility (SNF).
†Rated 4 weeks after discharge SNF.
Table 2.
Care coordination according to professionals (elderly care physicians and nursing staff), patients and informal caregivers in percentage good and excellent. Selection of patients with completed professional data at baseline and not-died or having a readmission to hospital during their rehabilitation stay (n = 1018)
NS, Nursing staff; ECP, elderly care physician; P, patient; IC, informal caregiver. Values are numbers (% good and excellent) unless indicated otherwise. P for trend values were calculated with the Kruskal–Wallis test.
Professional rating N total: C1: n = 317; C2: n = 373; C3: n = 328.
Patient rating N total: C1:158; C2:193; C3:170.
Informal caregiver rating N total: C1:94; C2:121; C3:104.
*Rated at admission skilled nursing facility (SNF).
†Rated at discharge SNF.
‡Rated 4 weeks after discharge SNF.
Table 3.
Team cooperation according to professionals (elderly care physicians, nursing staff and physical therapists), patients and informal caregivers in percentage good and excellent. Selection of patients with completed professional data at baseline and not-died or having a readmission to hospital during their rehabilitation stay (n = 1018)
NS, Nursing staff; ECP, elderly care physician; PT, physical therapist; P, patient; IC, informal caregiver. Values are numbers (% good and excellent) unless indicated otherwise. P for trend values were calculated with the Kruskal–Wallis test.
*Rated at admission skilled nursing facility (SNF).
†Rated at discharge SNF.
‡Rated 4 weeks after discharge SNF.
Professional rating N total: C1: n = 317; C2: n = 373; C3: n = 328.
Patient rating N total: C1:158; C2:193; C3:170.
Informal caregiver rating N total: C1:94; C2:121; C3:104.
Table 4.
Care quality at discharge skilled nursing facility (SNF) according to nursing staff and at 4 weeks’ follow-up according to patients and informal caregivers in percentage good and excellent. Selection of patients with completed professional data at baseline and not-died or having a readmission to hospital during their rehabilitation stay (n = 1018)
SNF, Skilled nursing facility; NS, nursing staff; P, patient; IC, informal caregiver. Values are numbers (% good and excellent) unless indicated otherwise. P for trend values calculated with the Kruskal–Wallis test.
Professional rating N total: C1: n = 317; C2: n = 373; C3: n = 328.
Patient rating N total: C1:158; C2:193; C3:170.
Informal caregiver rating N total: C1:94; C2:121; C3:104.
*One-way ANOVA.
†Excellent.