Abstract
Hospital admission in older adults is associated with unwanted outcomes such as readmission, institutionalization, and functional decline. To reduce these outcomes, the Netherlands introduced an alternative to hospital-based care: the Acute Geriatric Community Hospital (AGCH). The AGCH is an acute care unit situated outside of a hospital focusing on early rehabilitation and comprehensive geriatric assessment. The objective of this study was to evaluate if AGCH care is associated with decreasing unplanned readmissions or death compared with hospital-based care.
Design
Prospective cohort study controlled with a historic cohort.
Setting and Participants
A (sub)acute care unit (AGCH) and 6 hospitals in the Netherlands; participants were acutely ill older adults.
Methods
We used inverse propensity score weighting to account for baseline differences. The primary outcome was 90-day readmission or death. Secondary outcomes included 30-day readmission or death, time to death, admission to long-term residential care, occurrence of falls and functioning over time. Generalized logistic regression models and multilevel regression analyses were used to estimate effects.
Results
AGCH patients (n = 206) had lower 90-day readmission or death rates [odds ratio (OR) 0.39, 95% CI 0.23-0.67] compared to patients treated in hospital (n = 401). AGCH patients had a lower risk of 90-day readmission (OR 0.38, 95% CI 0.21-0.67) but did not differ on all-cause mortality (OR 0.89, 95% CI 0.44-1.79) compared with the hospital control group. AGCH patients had lower 30-day readmission or death rates. Secondary outcomes did not differ.
Conclusions and Implications
AGCH patients had lower rates of readmission and/or death than patients treated in a hospital. Our results support further research on the implementation and cost-effectiveness of AGCH in the Netherlands and other countries seeking alternatives to hospital-based care.
| Original language | English |
|---|---|
| Pages (from-to) | 704-710 |
| Number of pages | 7 |
| Journal | Journal of the American Medical Directors Association |
| Volume | 25 |
| Issue number | 4 |
| Early online date | 27 Dec 2023 |
| DOIs | |
| Publication status | Published - Dec 2023 |
Funding
Research at the Acute Geriatric Community Hospital (AGCH, Amsterdam University Medical Centers) is funded by ZonMw, the Netherlands Organization for Health Research and Development (project number 808393598041), and the PVE fund. Care is provided at the AGCH in a partnership between Cordaan (a community, intermediate, and home care organization) and the Amsterdam University Medical Center, location Academic Medical Centre. The AGCH is financially supported by Zilveren Kruis, a health insurance company. Funders were not involved in the design of the study. Zilveren Kruis approved the studied outcome measures. Research at the Acute Geriatric Community Hospital (AGCH, Amsterdam University Medical Centers ) is funded by ZonMw, the Netherlands Organization for Health Research and Development (project number 808393598041), and the PVE fund. Care is provided at the AGCH in a partnership between Cordaan (a community, intermediate, and home care organization) and the Amsterdam University Medical Center, location Academic Medical Centre. The AGCH is financially supported by Zilveren Kruis , a health insurance company. Funders were not involved in the design of the study. Zilveren Kruis approved the studied outcome measures.
| Funders | Funder number |
|---|---|
| AGCH | |
| ZonMw | 808393598041 |