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.
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。