Investigating the Effectiveness of Care Delivery at an Acute Geriatric Community Hospital for Older Adults in the Netherlands: A Prospective Controlled Observational Study

Marthe E Ribbink; Janet L MacNeil Vroomen; Remco Franssen; Daisy Kolk; Ângela Jornada Ben; Hanna C Willems; Bianca M Buurman; AGCH study group

doi:10.1016/j.jamda.2023.11.018

Investigating the Effectiveness of Care Delivery at an Acute Geriatric Community Hospital for Older Adults in the Netherlands: A Prospective Controlled Observational Study

J Am Med Dir Assoc. 2024 Apr;25(4):704-710. doi: 10.1016/j.jamda.2023.11.018. Epub 2023 Dec 27.

Authors

Marthe E Ribbink¹, Janet L MacNeil Vroomen², Remco Franssen², Daisy Kolk³, Ângela Jornada Ben⁴, Hanna C Willems², Bianca M Buurman⁵; AGCH study group

Affiliations

¹ Department of Internal Medicine, Section of Geriatric Medicine, Amsterdam Public Health Research Institute, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands. Electronic address: m.e.ribbink@amsterdamumc.nl.
² Department of Internal Medicine, Section of Geriatric Medicine, Amsterdam Public Health Research Institute, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands.
³ Department of Internal Medicine, Section of Geriatric Medicine, Amsterdam Public Health Research Institute, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands; Department of Medicine for Older People, Amsterdam Public Health Research Institute, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands.
⁴ Department of Health Sciences, Faculty of Science, Vrije Universiteit Amsterdam, Amsterdam Public Health Research Institute, the Netherlands.
⁵ Department of Internal Medicine, Section of Geriatric Medicine, Amsterdam Public Health Research Institute, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands; Department of Medicine for Older People, Amsterdam Public Health Research Institute, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands; ACHIEVE - Center of Applied Research, Faculty of Health, Amsterdam University of Applied Sciences, Amsterdam, the Netherlands.

PMID: 38159913
DOI: 10.1016/j.jamda.2023.11.018

Abstract

Objectives: 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.

Design: Prospective cohort study controlled with a historic cohort.

Setting and participants: 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 and implications: 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.

Keywords: Older adults; community hospital; hospitalization; intermediate care.

Publication types

Observational Study

MeSH terms

Aged
Hospitalization
Hospitals, Community*
Humans
Netherlands
Patient Discharge*
Patient Readmission
Prospective Studies