The influence of an intermediate care hospital on health care utilization among elderly patients - a retrospective comparative cohort study
Journal article, Peer reviewed
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http://hdl.handle.net/11250/300457Utgivelsesdato
2015Metadata
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Sammendrag
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.
Keywords: Intermediate care hospital, Hospital discharge, Health care utilization, Length of stay, Readmission, Primary
health care, Elderly.