Effectiveness of an intermediate care hospital on readmissions, mortality, activities of daily living and use of health care services among hospitalized adults aged 60 years and older; a controlled observational study

摘要

Background: Intermediate care is a health care model developed to optimize the coordination of health careservices and functional independence. In Central Norway, an intermediate care hospital (ICH) was established in amunicipality to improve hospital discharge and follow-up among elderly patients with chronic conditions andcomprehensive care needs. The aim of this study was to investigate the effectiveness of hospital discharges to amunicipality with an ICH compared to discharges to a municipality without an ICH.Methods: This was a non-randomized controlled observational study of hospitalized patients aged 60 years andolder from two municipalities. Patients (n = 328) admitted to a general hospital from February 2010 throughSeptember 2011 were included in the study and followed for 12 months. The data were analyzed using descriptivestatistics, analysis of covariance (ANCOVA) and Cox proportional hazard regression.Results: Each patient discharged from the general hospital to the municipality with an ICH had a shorter length ofstay and used on average 4.2 (p = 0.046) fewer hospital days during 1 year compared to patients from themunicipality without an ICH. Otherwise, no statistical significant differences were found between the municipalitiesin terms of hospital readmissions, admissions, mortality, activities of daily living, primary health care utilization ortotal care days. A post hoc analysis of patients discharged to the ICH compared to the municipality without an ICH,showed that the ICH patients were older and frailer, but the outcome was similar to the main analysis.Conclusions: Having an ICH in the municipality facilitated shorter length of hospital stay and kept the risk ofreadmissions, mortality and post-hospitalization care needs at the same level as without an ICH.