title: The influence of an intermediate care hospital on health care utilization among elderly patients--a retrospective comparative cohort study.
abstract: 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.
authors: Department of Public Health and General Practice, Norwegian University of Science and Technology, Medisinsk teknisk forskningssenter, Post box 8905 , 7491, Trondheim, Norway. unni.dahl@ntnu.no.|Central Norway Health Authority, 7500, Stjørdal, Norway. unni.dahl@ntnu.no.
authors: Unni
authors: U
authors: Dahl
authors: Department of Public Health and General Practice, Norwegian University of Science and Technology, Medisinsk teknisk forskningssenter, Post box 8905 , 7491, Trondheim, Norway. roar.johnsen@ntnu.no.
authors: Roar
authors: R
authors: Johnsen
authors: Department of Public Health and General Practice, Norwegian University of Science and Technology, Medisinsk teknisk forskningssenter, Post box 8905 , 7491, Trondheim, Norway. rune.saetre@idi.ntnu.no.
authors: Rune
authors: R
authors: Sætre
authors: Department of Public Health and General Practice, Norwegian University of Science and Technology, Medisinsk teknisk forskningssenter, Post box 8905 , 7491, Trondheim, Norway. aslak.steinsbekk@ntnu.no.
authors: Aslak
authors: A
authors: Steinsbekk
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D015331:Cohort Studies; D005260:Female; D006760:Hospitalization / Q000706:statistics & numerical data*; D006769:Hospitals, General / Q000706:statistics & numerical data; D006801:Humans; D007380:Intermediate Care Facilities / Q000706:statistics & numerical data*; D007902:Length of Stay / Q000706:statistics & numerical data*; D008297:Male; D008875:Middle Aged; D009664:Norway; D010342:Patient Acceptance of Health Care / Q000706:statistics & numerical data*; D010351:Patient Discharge / Q000706:statistics & numerical data; D011320:Primary Health Care / Q000706:statistics & numerical data*; D012189:Retrospective Studies; D014505:Urban Population / Q000706:statistics & numerical data
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