Effectiveness of community hospital-based post-acute care on functional recovery and 12-month mortality in older patients: a prospective cohort study.
BACKGROUND
Evidence supporting community hospital (CH)-based post-acute care (PAC) on long-term mortality is lacking.


METHODS
A 4-week comprehensive geriatric assessment-based interdisciplinary care was introduced to reable post-acute older patients who volunteered to participate in this study without randomization. The effectiveness of CH-based PAC in functional gain and 12-month mortality were evaluated.


RESULTS
Of 688 acute hospital admissions, 330 patients fulfilled the enrolment criteria; there were 96 (mean age 85.7 ± 5.1 years) in the intervention group and 234 (mean age 85.4 ± 5.3 years) in the reference group. Patients with experience of geriatric services (26.0% versus 16.2%; P = 0.04) and longer length-of-stay (18.0 ± 6.0 versus 15.2 ± 11.8 days; P = 0.028) were more likely to participate in the study. The pre-acute hospital discharge Barthel Index was significantly lower in the intervention group (46.3 ± 29.0 versus 85.1 ± 24.7; P < 0.001). The 4-week PAC programme significantly improved physical function, cognitive status, depressive moods, and pain. At the 12-month follow-up, 71 (21.5%) patients had died, and 3 (0.9%) were lost to follow-up. Adjusted for pre-acute hospital discharge Barthel Index and acute hospital length-of-stay, the intervention group was less likely to die (HR 0.38; 95% CI = 0.19-0.76; P = 0.006).


CONCLUSIONS
A 4-week CH-based interdisciplinary PAC programme significantly promoted functional recovery and reduced 12-month mortality by 62% for older post-acute patients.
Chen
Liang-Kung
LK
National Yang Ming University School of Medicine, Taipei, Taiwan.
Chen
Yi-Ming
YM
Hwang
Shinn-Jang
SJ
Peng
Li-Ning
LN
Lin
Ming-Hsien
MH
Lee
Wei-Ju
WJ
Lee
Chen-Hsen
CH
D000203:Activities of Daily Living; D000208:Acute Disease / Q000534:rehabilitation*; D000369:Aged, 80 and over; D019090:Case Management; D015577:Geriatric Assessment; D006764:Hospitals, Community / Q000379:methods*; D006801:Humans; D008297:Male; D009026:Mortality; D017063:Outcome Assessment, Health Care / Q000706:statistics & numerical data; D016016:Proportional Hazards Models; D011446:Prospective Studies; D020127:Recovery of Function; D019467:Subacute Care / Q000379:methods*