Effectiveness of community hospital-based post-acute care on functional recovery and 12-month mortality in older patients: a prospective cohort study.

摘要

BACKGROUND: Evidence supporting community hospital (CH)-based post-acute care (PAC) on long-term mortality is lacking. METHODS: A 4-week comprehensive geriatric assessment-based interdisciplinary care was introduced to reable post-acute older patients who volunteered to participate in this study without randomization. The effectiveness of CH-based PAC in functional gain and 12-month mortality were evaluated. RESULTS: Of 688 acute hospital admissions, 330 patients fulfilled the enrolment criteria; there were 96 (mean age 85.7 +/- 5.1 years) in the intervention group and 234 (mean age 85.4 +/- 5.3 years) in the reference group. Patients with experience of geriatric services (26.0% versus 16.2%; P = 0.04) and longer length-of-stay (18.0 +/- 6.0 versus 15.2 +/- 11.8 days; P = 0.028) were more likely to participate in the study. The pre-acute hospital discharge Barthel Index was significantly lower in the intervention group (46.3 +/- 29.0 versus 85.1 +/- 24.7; P < 0.001). The 4-week PAC programme significantly improved physical function, cognitive status, depressive moods, and pain. At the 12-month follow-up, 71 (21.5%) patients had died, and 3 (0.9%) were lost to follow-up. Adjusted for pre-acute hospital discharge Barthel Index and acute hospital length-of-stay, the intervention group was less likely to die (HR 0.38; 95% CI = 0.19-0.76; P = 0.006). CONCLUSION: A 4-week CH-based interdisciplinary PAC programme significantly promoted functional recovery and reduced 12-month mortality by 62% for older post-acute patients.