Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress
Clinical Collections
Advances in Alzheimer’s

Keynote webinar | Spotlight on medication adherence

LIVE: Thursday 27th June 2024, 18:00-19:30 (CEST)
Join our expert panel to discover why you need to understand the drivers of non-adherence in your patients, and how you can optimize medication adherence in your clinics to drastically improve patient outcomes.
ADVANCED SEARCH
Log in
Top
BMC Health Services Research
Published in: BMC Health Services Research 1/2015

Open Access 01-12-2015 | Research article

The influence of an intermediate care hospital on health care utilization among elderly patients - a retrospective comparative cohort study

Authors: Unni Dahl, Roar Johnsen, Rune Sætre, Aslak Steinsbekk

Published in: BMC Health Services Research | Issue 1/2015

Login to get access

Abstract

Background

An intermediate care hospital (ICH) was established in a municipality in Central Norway in 2007 to improve the coordination of services and follow-up among elderly and chronically ill patients after hospital discharge. The aim of this study was to compare health care utilization by elderly patients in a municipality with an ICH to that of elderly patients in a municipality without an ICH.

Methods

This study was a retrospective comparative cohort study of all hospitalized patients aged 60 years or older in two municipalities. The data were collected from the national register of hospital use from 2005 to 2012, and from the local general hospital and two primary health care service providers from 2008 to 2012 (approx. 1,250 patients per follow-up year). The data were analyzed using descriptive statistics and analysis of covariance (ANCOVA).

Results

The length of hospital stay decreased from the time the ICH was introduced and remained between 10% and 22% lower than the length of hospital stay in the comparative municipality for the next five years. No differences in the number of readmissions or admissions during one year follow-up after the index stay at the local general hospital or changes in primary health care utilization were observed. In the year after hospital discharge, the municipality with an ICH offered more hour-based care to elderly patients living at home (estimated mean = 234 [95% CI 215-252] versus 175 [95% CI 154-196] hours per person and year), while the comparative municipality had a higher utilization of long-term stays in nursing homes (estimated mean = 33.3 [95% CI 29.0-37.7] versus 21.9 [95% CI 18.0-25.7] days per person and year).

Conclusions

This study indicates that the introduction of an ICH rapidly reduces the length of hospital stay without exposing patients to an increased health risk. The ICH appears to operate as an extension of the general hospital, with only a minor impact on the pattern of primary health care utilization.
Literature
1.
2.
3.
Bodenheimer T. Coordinating care–a perilous journey through the health care system. N Engl J Med. 2008;358(10):1064–71.CrossRefPubMed
4.
Challis D, Hughes J, Xie C, Jolley D. An examination of factors influencing delayed discharge of older people from hospital. Int J Geriatr Psychiatry. 2014;29(2):160–8.CrossRefPubMed
5.
6.
Jasinarachchi KH, Ibrahim IR, Keegan BC, Mathialagan R, McGourty JC, Phillips JR, et al. Delayed transfer of care from NHS secondary care to primary care in England: its determinants, effect on hospital bed days, prevalence of acute medical conditions and deaths during delay, in older adults aged 65 years and over. BMC Geriatr. 2009;9:4.CrossRefPubMedPubMedCentral
7.
Laugaland K, Aase K, Barach P. Interventions to improve patient safety in transitional care–a review of the evidence. Work. 2012;41 Suppl 1:2915–24.PubMed
8.
Lenzi J, Mongardi M, Rucci P, Di Ruscio E, Vizioli M, Randazzo C, et al. Sociodemographic, clinical and organisational factors associated with delayed hospital discharges: a cross-sectional study. BMC Health Serv Res. 2014;14:128.CrossRefPubMedPubMedCentral
9.
Jencks SF, Williams MV, Coleman EA. Rehospitalizations among patients in the Medicare fee-for-service program. N Engl J Med. 2009;360(14):1418–28.CrossRefPubMed
10.
11.
Wright PN, Tan G, Iliffe S, Lee D. The impact of a new emergency admission avoidance system for older people on length of stay and same-day discharges. Age Ageing. 2014;43(1):116–21.CrossRefPubMed
12.
13.
Fearon P, Langhorne P. Services for reducing duration of hospital care for acute stroke patients. Cochrane Database Syst Rev. 2012;9:CD000443.PubMed
14.
Parker SG, Peet SM, McPherson A, Cannaby AM, Abrams K, Baker R, et al. A systematic review of discharge arrangements for older people. Health Technol Assess. 2002;6(4):1–183.CrossRefPubMed
15.
Shepperd S, Lannin NA, Clemson LM, McCluskey A, Cameron ID, Barras SL. Discharge planning from hospital to home. Cochrane Database Syst Rev. 2013;1:CD000313.PubMed
16.
17.
Garasen H, Windspoll R, Johnsen R. Intermediate care at a community hospital as an alternative to prolonged general hospital care for elderly patients: a randomised controlled trial. BMC Public Health. 2007;7:68.CrossRefPubMedPubMedCentral
18.
Plochg T, Delnoij DM, van der Kruk TF, Janmaat TA, Klazinga NS. Intermediate care: for better or worse? Process evaluation of an intermediate care model between a university hospital and a residential home. BMC Health Serv Res. 2005;5:38.CrossRefPubMedPubMedCentral
19.
Brusco NK, Taylor NF, Hornung I, Schaffers S, Smith A, de Morton NA. Factors that predict discharge destination for patients in transitional care: a prospective observational cohort study. Aust Health Rev. 2012;36(4):430–6.CrossRefPubMed
20.
Parsons M, Senior HE, Kerse N, Chen MH, Jacobs S, Vanderhoorn S, et al. The Assessment of Services Promoting Independence and Recovery in Elders Trial (ASPIRE): a pre-planned meta-analysis of three independent randomised controlled trial evaluations of ageing in place initiatives in New Zealand. Age Ageing. 2012;41(6):722–8.CrossRefPubMed
21.
Young J. The development of intermediate care services in England. Arch Gerontol Geriatr. 2009;49 Suppl 2:S21–5.CrossRefPubMed
22.
Pearson MHH, Cooper C, Shepperd S, Pawson R, Anderson R. Intermediate Care: A Realist Review and Conseptual Framework. Final Report. Southampton: NIHR Service Delivery and Organisation programme; 2013.
23.
Griffiths PD, Edwards MH, Forbes A, Harris RL, Ritchie G. Effectiveness of intermediate care in nursing-led in-patient units. Cochrane Database Syst Rev. 2007;2:CD002214.PubMed
24.
Green J, Young J, Forster A, Mallinder K, Bogle S, Lowson K, et al. Effects of locality based community hospital care on independence in older people needing rehabilitation: randomised controlled trial. BMJ. 2005;331(7512):317–22.CrossRefPubMedPubMedCentral
25.
Young J, Green J, Forster A, Small N, Lowson K, Bogle S, et al. Postacute care for older people in community hospitals: a multicenter randomized, controlled trial. J Am Geriatr Soc. 2007;55(12):1995–2002.CrossRefPubMed
26.
Shepperd S, Doll H, Broad J, Gladman J, Iliffe S, Langhorne P, et al. Early discharge hospital at home. Cochrane Database Syst Rev. 2009;1:CD000356.PubMed
27.
Grimley Evans J, Tallis RC. A new beginning for care for elderly people? BMJ. 2001;322(7290):807–8.CrossRefPubMed
28.
29.
Woodford HJ, George J. Intermediate care for older people in the U.K. Clin Med. 2010;10(2):119–23.CrossRef
30.
31.
32.
33.
34.
Dahl U, Steinsbekk A, Jenssen S, Johnsen R. Hospital discharge of elderly patients to primary health care, with and without an intermediate care hospital - a qualitative study of health professionals’ experiences. Int J Integr Care. 2014;14:e011.CrossRefPubMedPubMedCentral
35.
36.
37.
Halfon P, Eggli Y, Pretre-Rohrbach I, Meylan D, Marazzi A, Burnand B. Validation of the potentially avoidable hospital readmission rate as a routine indicator of the quality of hospital care. Med Care. 2006;44(11):972–81.CrossRefPubMed
38.
Yam CH, Wong EL, Chan FW, Wong FY, Leung MC, Yeoh EK. Measuring and preventing potentially avoidable hospital readmissions: a review of the literature. Hong Kong Med J. 2010;16(5):383–9.PubMed
39.
40.
41.
Hennekens CH, Buring JE. Epidemiology in Medicine. Little, Brown and company: Boston/Toronto; 1987.
42.
43.
OECD. Health at a Glance: Europe 2012. Paris: OECD Publishing; 2012.
44.
45.
Epstein AM. Revisiting readmissions–changing the incentives for shared accountability. N Engl J Med. 2009;360(14):1457–9.CrossRefPubMed
46.
Schiotz M, Price M, Frolich A, Sogaard J, Kristensen JK, Krasnik A, et al. Something is amiss in Denmark: a comparison of preventable hospitalisations and readmissions for chronic medical conditions in the Danish Healthcare system and Kaiser Permanente. BMC Health Serv Res. 2011;11:347.CrossRefPubMedPubMedCentral
47.
48.
Heggestad T. Do hospital length of stay and staffing ratio affect elderly patients’ risk of readmission? A nation-wide study of Norwegian hospitals. Health Serv Res. 2002;37(3):647–65.CrossRefPubMedPubMedCentral
Metadata
Title
The influence of an intermediate care hospital on health care utilization among elderly patients - a retrospective comparative cohort study
Authors
Unni Dahl
Roar Johnsen
Rune Sætre
Aslak Steinsbekk
Publication date
01-12-2015
Publisher
BioMed Central
Published in
BMC Health Services Research / Issue 1/2015
Electronic ISSN: 1472-6963
DOI
https://doi.org/10.1186/s12913-015-0708-4

Other articles of this Issue 1/2015

BMC Health Services Research 1/2015 Go to the issue

Research article

Developing a programme theory to explain how primary health care teams learn to respond to intimate partner violence: a realist case-study

Research article

Experiences of Latinos with limited English proficiency with patient registration systems and their interactions with clinic front office staff: an exploratory study to inform community-based translational research in North Carolina

Research article

Evaluation of the regional nurse-supported hepatitis C shared care program in Western Australia: a mixed methods study

Research article

Determining the predictors of innovation implementation in healthcare: a quantitative analysis of implementation effectiveness

Research article

Acute and chronic impact of cardiovascular events on health state utilities

Research article

Organizational culture in cardiovascular care in Chinese hospitals: a descriptive cross-sectional study