title: Direct admission to intermediate care for older adults with reactivated chronic diseases as an alternative to conventional hospitalization.
abstract: BACKGROUND
  When reactivations of chronic diseases cannot be managed at home, postacute intermediate-care geriatric units (ICGUs) might provide adequate and specialized support to primary care, based on comprehensive geriatric assessment and rehabilitation.
  
  
  OBJECTIVE
  To explore if direct admission to ICGUs of older adults with reactivated chronic diseases or acute common conditions superimposed to chronic diseases might be an alternative clinical pathway to conventional acute hospitalization followed by intermediate care rehabilitation.
  
  
  METHODS
  Quasiexperimental pilot study. We compared characteristics at admission and outcomes at discharge between two groups admitted to our ICGU: the first one admitted directly, and the second one admitted to complete treatment and rehabilitation after discharge from acute hospital.
  
  
  RESULTS
  Sixty-five patients from the same primary care area (mean age ± SD 85.6 ± 7.2, 66% women) were admitted to the ICGU for the same main diagnostics, mainly reactivation of heart failure and chronic obstructive pulmonary disease: 32 directly from home (DA) and 33 following acute hospital discharge (HD). Baseline clinical, functional, and social characteristics, as well as outcomes at discharge, including mortality and acute transfers, were comparable between groups. Global length of stay was significantly higher in HD, compared with DA (60.8 ± 26.6 vs 38.4 ± 23 days, P < .001).
  
  
  CONCLUSIONS
  From our preliminary results, direct admission to geriatric intermediate care units might represent a potential alternative to acute hospitalization for selected older patients.
authors.affiliation: Hospital Socio-Sanitari Pere Virgili, Barcelona, Spain. dcolprim@perevirgili.catsalut.net
authors.forename: Daniel
authors.initials: D
authors.lastname: Colprim
authors.forename: Remedios
authors.initials: R
authors.lastname: Martin
authors.forename: Maria
authors.initials: M
authors.lastname: Parer
authors.forename: Judith
authors.initials: J
authors.lastname: Prieto
authors.forename: Luis
authors.initials: L
authors.lastname: Espinosa
authors.forename: Marco
authors.initials: M
authors.lastname: Inzitari
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D002908:Chronic Disease; D005260:Female; D006299:Health Services for the Aged / Q000458:organization & administration; D006333:Heart Failure / Q000534:rehabilitation*; D006801:Humans; D057187:Independent Living; D007362:Intensive Care Units; D007380:Intermediate Care Facilities / Q000458:organization & administration*; D008297:Male; D010343:Patient Admission / Q000706:statistics & numerical data*; D010865:Pilot Projects; D011379:Prognosis; D029424:Pulmonary Disease, Chronic Obstructive / Q000534:rehabilitation*; D020127:Recovery of Function; D012008:Recurrence