title: Evaluation of Ambulatory Geriatric Rehabilitation (EAGER): study protocol of a matched cohort study based on claims data.
abstract: Ambulatory geriatric rehabilitation (AGR) is a community based outpatient intervention which aims to improve physical function, maintain independent living of geriatric patients, avoiding hospitalisation and institutionalisation. It should therefore reduce health care costs. The objective of our study is to evaluate the effectiveness of AGR for frail elderly patients insured by the statutory health insurance AOK Nordost compared to care as usual. Outcome variables are progression to higher nursing care levels, admission to nursing home, incident fractures, hospital admission, ambulatory care sensitive hospital admissions, days spent in hospital, and health care costs.
  
  
  
  This matched cohort study aims to estimate average treatment effects of AGR. For this purpose we will compare patients receiving AGR with matched patients receiving care as usual. Patients in the intervention group were treated between the years 2009 and 2013 from three centres in Mecklenburg-Vorpommern, Germany. Matching will be conducted using propensity score techniques. Claims data will be provided by the statutory health insurance AOK Nordost. The primary outcomes are the progression of nursing care levels, incident fractures, and admission to nursing home. Secondary outcomes are total and ambulatory care sensitive hospital admissions, and health care costs from the statutory health insurance perspective. Data will be analysed using appropriate regression models.
  
  
  
  This study aims to quantify the effectiveness of AGR. Results will be important for providers of AGR, policy makers and stakeholders to make informed decisions on whether to continue, modify or extend AGR.
  
  
  
  German Clinical Trials Register (DRKS) S00008926 , registered 29.07.2015.
authors.affiliation: Department of General Practice, Institute of Community Medicine, University Medicine Greifswald, Greifswald, Germany. allgemeinmedizin@uni-greifswald.de.|Institut für Community Medicine-Abteilung Allgemeinmedizin, Universitätsmedizin Greifswald, KdöR, Fleischmannstraße 42, 17475, Greifswald, Germany. allgemeinmedizin@uni-greifswald.de.
authors.forename: Simone
authors.initials: S
authors.lastname: Kiel
authors.affiliation: Department of SHIP-KEF, Institute of Community Medicine, University Medicine Greifswald, Greifswald, Germany.
authors.forename: Carolin
authors.initials: C
authors.lastname: Zimak
authors.affiliation: Department of General Practice, Institute of Community Medicine, University Medicine Greifswald, Greifswald, Germany.
authors.forename: Jean-François
authors.initials: JF
authors.lastname: Chenot
authors.affiliation: Department of SHIP-KEF, Institute of Community Medicine, University Medicine Greifswald, Greifswald, Germany.
authors.forename: Carsten Oliver
authors.initials: CO
authors.lastname: Schmidt
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000553:Ambulatory Care / Q000379:methods*; D015331:Cohort Studies; D005260:Female; D050723:Fractures, Bone / Q000453:epidemiology / Q000534:rehabilitation; D016330:Frail Elderly / Q000706:statistics & numerical data*; D015577:Geriatric Assessment / Q000379:methods; D005858:Germany / Q000453:epidemiology; D017048:Health Care Costs / Q000706:statistics & numerical data; D054624:Health Status Disparities; D006760:Hospitalization / Q000706:statistics & numerical data; D006801:Humans; D007345:Insurance Claim Review / Q000706:statistics & numerical data; D008297:Male; D009735:Nursing Homes / Q000706:statistics & numerical data; D016896:Treatment Outcome
keywords: Ambulatory geriatric rehabilitation; Geriatric multimorbidity; Health claims data; Matched cohort study; Propensity score matching