title: Six month outcomes after emergency admission of elderly patients to a community or a district general hospital.
abstract: BACKGROUND
  Emergency admissions account for 40% of National Health Service bed usage. Recent policy is to increase the role of intermediate care, which includes the use of community hospitals (CHs). However, the proposed expansion presumes that CH care is as effective as acute hospital care. No direct comparison of outcomes between CHs and district general hospitals (DGHs) has been undertaken.
  
  
  OBJECTIVE
  The aim of this study was to compare patient-based outcomes at 6 months following emergency admission to a DGH or CH.
  
  
  METHODS
  We designed a prospective cohort study, with strict eligibility criteria. The study was set in one DGH and five CHs in Devon, UK. Study participants were people aged >70 years with an acute illness requiring hospital admission, but whose condition could have been treated in either hospital setting. A cohort of people admitted to each setting was identified and followed-up for 6 months. The primary outcome measure was change in quality of life 6 months after admission, as measured by SF-36 and EuroQol. Secondary outcome measures were death, readmission and place of residence at 6 months. The use of drugs and investigations during the hospital stay were also measured.
  
  
  RESULTS
  A total of 376 patients were recruited and completed baseline measures, 254 of whom were followed-up at the 6-month stage (136 CH, 118 DGH). There were no differences in outcome between settings, with a small increase in quality of life scores at 6 months in both cohorts: the mean change in EuroQol 5D in CH was 6.6 points (95% confidence interval, 2.8-10.4) and in DGH was 6.5 (2.4-10.7); P = 0.97. Mortality and place of residence at 6 months were similar in the two groups. The numbers of investigations (median CH four investigations, DGH 22; P < 0.001) and of prescribed medications during the hospital stay (median CH eight drugs, DGH 11; P < 0.001) were significantly higher in the DGH.
  
  
  CONCLUSIONS
  The quality of life and mortality in the CH cohort was similar to those in the DGH cohort. CH care can be used as an alternative to DGH care for a wide range of conditions requiring emergency admission.
authors.affiliation: East Devon PCT, North and East Devon Health Authority, UK. Ali.Round@EastDevon-PCT.nhs.uk
authors.forename: Alison
authors.initials: A
authors.lastname: Round
authors.forename: Tania
authors.initials: T
authors.lastname: Crabb
authors.forename: Ken
authors.initials: K
authors.lastname: Buckingham
authors.forename: Richard
authors.initials: R
authors.lastname: Mejzner
authors.forename: Vaughan
authors.initials: V
authors.lastname: Pearce
authors.forename: Reuben
authors.initials: R
authors.lastname: Ayres
authors.forename: Catherine
authors.initials: C
authors.lastname: Weeks
authors.forename: William
authors.initials: W
authors.lastname: Hamilton
mesh_terms: D017677:Age Distribution; D000368:Aged; D000369:Aged, 80 and over; D015331:Cohort Studies; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data*; D004739:England; D005260:Female; D006764:Hospitals, Community / Q000706:statistics & numerical data*; D006767:Hospitals, District / Q000706:statistics & numerical data*; D006769:Hospitals, General / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D017063:Outcome Assessment, Health Care / Q000706:statistics & numerical data*; D011446:Prospective Studies; D011788:Quality of Life; D017678:Sex Distribution