Intermediate care at a community hospital as an alternative to prolonged general hospital care for elderly patients: a randomised controlled trial.
BACKGROUND
Demographic changes together with an increasing demand among older people for hospital beds and other health services make allocation of resources to the most efficient care level a vital issue. The aim of this trial was to study the efficacy of intermediate care at a community hospital compared to standard prolonged care at a general hospital.


METHODS
In a randomised controlled trial 142 patients aged 60 or more admitted to a general hospital due to acute illness or exacerbation of a chronic disease 72 (intervention group) were randomised to intermediate care at a community hospital and 70 (general hospital group) to further general hospital care.


RESULTS
In the intervention group 14 patients (19.4%) were readmitted for the same disease compared to 25 patients (35.7%) in the general hospital group (p = 0.03). After 26 weeks 18 (25.0%) patients in the intervention group were independent of community care compared to seven (10.0%) in the general hospital group (p = 0.02). There were an insignificant reduction in the number of deaths and an insignificant increase in the number of days with inward care in the intervention group. The number of patients admitted to long-term nursing homes from the intervention group was insignificantly higher than from the general hospital group.


CONCLUSIONS
Intermediate care at a community hospital significantly decreased the number of readmissions for the same disease to general hospital, and a significantly higher number of patients were independent of community care after 26 weeks of follow-up, without any increase in mortality and number of days in institutions.
Garåsen
Helge
H
Department of Public Health and General Practice, Faculty of Medicine, The Norwegian University of Science and Technology (NTNU), Trondheim, Norway. helge.garasen@ntnu.no
Windspoll
Rolf
R
Johnsen
Roar
R
D000208:Acute Disease; D000368:Aged; D002908:Chronic Disease; D017598:Efficiency, Organizational; D005260:Female; D006764:Hospitals, Community / Q000191:economics / Q000458:organization & administration / Q000706:statistics & numerical data*; D006769:Hospitals, General / Q000191:economics / Q000706:statistics & numerical data*; D006785:Hospitals, University / Q000191:economics / Q000706:statistics & numerical data; D006801:Humans; D007380:Intermediate Care Facilities / Q000458:organization & administration / Q000706:statistics & numerical data*; D053208:Kaplan-Meier Estimate; D007902:Length of Stay / Q000191:economics / Q000706:statistics & numerical data*; D008297:Male; D008875:Middle Aged; D009664:Norway / Q000453:epidemiology; D010043:Outcome and Process Assessment, Health Care; D010359:Patient Readmission / Q000706:statistics & numerical data*; D011383:Progressive Patient Care; D019467:Subacute Care