Abstract：
OBJECTIVE: Hospital admission in older adults is associated with unwanted outcomes such as readmission, institutionalization, and functional decline. To reduce these outcomes, the Netherlands introduced an alternative to hospital-based care: the Acute Geriatric Community Hospital (AGCH). The AGCH is an acute care unit situated outside of a hospital focusing on early rehabilitation and comprehensive geriatric assessment. The objective of this study was to evaluate if AGCH care is associated with decreasing unplanned readmissions or death compared with hospital-based care.
METHODS: Prospective cohort study controlled with a historic cohort.
METHODS: A (sub)acute care unit (AGCH) and 6 hospitals in the Netherlands; participants were acutely ill older adults.
METHODS: We used inverse propensity score weighting to account for baseline differences. The primary outcome was 90-day readmission or death. Secondary outcomes included 30-day readmission or death, time to death, admission to long-term residential care, occurrence of falls and functioning over time. Generalized logistic regression models and multilevel regression analyses were used to estimate effects.
RESULTS: AGCH patients (n = 206) had lower 90-day readmission or death rates [odds ratio (OR) 0.39, 95% CI 0.23-0.67] compared to patients treated in hospital (n = 401). AGCH patients had a lower risk of 90-day readmission (OR 0.38, 95% CI 0.21-0.67) but did not differ on all-cause mortality (OR 0.89, 95% CI 0.44-1.79) compared with the hospital control group. AGCH patients had lower 30-day readmission or death rates. Secondary outcomes did not differ.
CONCLUSIONS: AGCH patients had lower rates of readmission and/or death than patients treated in a hospital. Our results support further research on the implementation and cost-effectiveness of AGCH in the Netherlands and other countries seeking alternatives to hospital-based care.
METHODS: Prospective cohort study controlled with a historic cohort.
METHODS: A (sub)acute care unit (AGCH) and 6 hospitals in the Netherlands; participants were acutely ill older adults.
METHODS: We used inverse propensity score weighting to account for baseline differences. The primary outcome was 90-day readmission or death. Secondary outcomes included 30-day readmission or death, time to death, admission to long-term residential care, occurrence of falls and functioning over time. Generalized logistic regression models and multilevel regression analyses were used to estimate effects.
RESULTS: AGCH patients (n = 206) had lower 90-day readmission or death rates [odds ratio (OR) 0.39, 95% CI 0.23-0.67] compared to patients treated in hospital (n = 401). AGCH patients had a lower risk of 90-day readmission (OR 0.38, 95% CI 0.21-0.67) but did not differ on all-cause mortality (OR 0.89, 95% CI 0.44-1.79) compared with the hospital control group. AGCH patients had lower 30-day readmission or death rates. Secondary outcomes did not differ.
CONCLUSIONS: AGCH patients had lower rates of readmission and/or death than patients treated in a hospital. Our results support further research on the implementation and cost-effectiveness of AGCH in the Netherlands and other countries seeking alternatives to hospital-based care.
摘要：
目的：老年人入院与不必要的结局有关，例如再次入院，制度化,功能下降。为了减少这些结果，荷兰引入了医院护理的替代方案:急性老年社区医院(AGCH).AGCH是位于医院外的急性护理单位，专注于早期康复和全面的老年评估。这项研究的目的是评估与医院护理相比，AGCH护理是否与减少计划外再入院或死亡相关。
方法：以历史队列为对照的前瞻性队列研究。
方法：荷兰的A（亚）急性监护病房（AGCH）和6家医院；参与者为患有严重疾病的老年人。
方法：我们使用逆倾向评分加权来解释基线差异。主要结果是90天再入院或死亡。次要结局包括30天再入院或死亡，时间到死亡,接受长期住宿护理，跌倒的发生和随着时间的推移而发挥作用。使用广义逻辑回归模型和多水平回归分析来估计效果。
结果：AGCH患者（n=206）的90天再入院或死亡率[比值比（OR）0.39，95％CI0.23-0.67]低于住院患者（n=401）。与医院对照组相比，AGCH患者90天再入院的风险较低（OR0.38，95％CI0.21-0.67），但全因死亡率没有差异（OR0.89，95％CI0.44-1.79）。AGCH患者30天再入院或死亡率较低。次要结果没有差异。
结论：AGCH患者的再入院率和/或死亡率低于在医院接受治疗的患者。我们的结果支持在荷兰和其他国家寻求替代医院护理的AGCH的实施和成本效益的进一步研究。
方法：以历史队列为对照的前瞻性队列研究。
方法：荷兰的A（亚）急性监护病房（AGCH）和6家医院；参与者为患有严重疾病的老年人。
方法：我们使用逆倾向评分加权来解释基线差异。主要结果是90天再入院或死亡。次要结局包括30天再入院或死亡，时间到死亡,接受长期住宿护理，跌倒的发生和随着时间的推移而发挥作用。使用广义逻辑回归模型和多水平回归分析来估计效果。
结果：AGCH患者（n=206）的90天再入院或死亡率[比值比（OR）0.39，95％CI0.23-0.67]低于住院患者（n=401）。与医院对照组相比，AGCH患者90天再入院的风险较低（OR0.38，95％CI0.21-0.67），但全因死亡率没有差异（OR0.89，95％CI0.44-1.79）。AGCH患者30天再入院或死亡率较低。次要结果没有差异。
结论：AGCH患者的再入院率和/或死亡率低于在医院接受治疗的患者。我们的结果支持在荷兰和其他国家寻求替代医院护理的AGCH的实施和成本效益的进一步研究。
