1. Effectiveness of community hospital post-acute care on mortality, re-admission, institutionalization, and activation of a home care programme in Emilia-Romagna region, Italy.
- Author
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Di Girolamo, Chiara, Leucci, Anna Caterina, Sforza, Stefano, Moro, Maria Luisa, and Berti, Elena
- Subjects
TREATMENT of respiratory diseases ,CHRONIC disease treatment ,TREATMENT of diabetes ,HOSPITALS ,EVALUATION of medical care ,REHABILITATION centers ,EVALUATION of human services programs ,CLINICAL trials ,CONFIDENCE intervals ,HOME care services ,CHRONIC diseases ,PATIENT readmissions ,HOSPITAL admission & discharge ,SUBACUTE care ,RISK assessment ,CRITICAL care medicine ,PUBLIC hospitals ,RESEARCH funding ,HOSPITAL care of older people ,DESCRIPTIVE statistics ,INSTITUTIONAL care ,PROPRIETARY hospitals ,LONG-term health care ,HEART diseases ,LONGITUDINAL method - Abstract
Background: In Italy, there is scant evidence on the impact of Community Hospitals (CHs) on clinical outcomes. Aims: To assess the effectiveness of CHs versus long-term care hospital or inpatient rehabilitation facilities on mortality, re-admission, institutionalization, and activation of a home care programme in the Emilia-Romagna Region (ERR-Italy) after acute hospitalisation. Methods: We implemented a cohort study drawing upon the ERR Administrative Healthcare Database System and including hospital episodes of ERR residents subject ≥ 65 years, discharged from a public or private hospital with a medical diagnosis to a CH or to usual care between 2017 and 2019. To control for confounding, we applied a propensity score matching. Results: Patients transferred to CHs had a significantly lower risk of dying but an increased risk of being readmitted to community or acute hospital within 30/90 days from discharge. The hazard of institutionalisation within 30/90 days was significantly lower in the whole population of the CH exposed group but not among patients with cardiac or respiratory chronic diseases or diabetes. The activation of a home care program within 90 days was slightly higher for those who were transferred to a CH. Discussion: The findings of our study show mixed effects on outcomes of patients transferred to CHs compared to those who followed the post-acute usual care and should be taken with cautious as could be affected by the so-called 'confounding by indication'. Conclusions: The study contributes to the intermediate care available evidence from a region with a well-established care provision through CHs. [ABSTRACT FROM AUTHOR]
- Published
- 2023
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