Long-term patients' outcomes after intermediate care at a community hospital for elderly patients: 12-month follow-up of a randomized controlled trial.

摘要

BACKGROUND: Developing a better understanding of if, and when, patients need care at a general hospital is an urgent challenge, as the proportion of general hospital beds being occupied by older patients is continuously increasing. METHODS: In a randomized controlled trial, of 142 patients aged 60 years or more admitted to a city general hospital due to acute illness or exacerbation of a chronic disease, 72 (intervention group) were randomized to intermediate care at a community hospital, and 70 (general hospital group) to further general hospital care. The patients were followed up for 12 months. The need for long-term home care and nursing homes, mortality and the number of admissions and days in general hospital for all diseases were monitored. RESULTS: Thirty-five patients, 13 (18.1%) of the patients included in the intervention group and 22 (31.4%) in the general hospital group, died within 12 months (p=0.03). Patients in the intervention group were observed for a longer period of time than those in the general hospital group; 335.7 (95% confidence interval (CI) 312.0-359.4) vs. 292.8 (95% CI 264.1-321.5) days (p=0.01). There were statistically no differences in the need for long-term primary-level care or in the number of admissions or days spent in general hospital beds. CONCLUSIONS: Intermediate care at the community hospital in Trondheim is an equal alternative to ordinary prolonged care at the city general hospital, as fewer patients were in need of community care services, and significantly fewer patients died during the 12-month follow-up time.