to compare the cost effectiveness of post-acute care for older people provided in community hospitals with general hospital care.
cost-effectiveness study embedded within a randomised controlled trial.
seven community hospitals and five general hospitals at five centres in the midlands and north of England. Participants: 490 patients needing rehabilitation following hospital admission with an acute illness. Intervention: multidisciplinary team care for older people in community hospitals.
EuroQol EQ-5D scores transformed into quality-adjusted life years; health and social service costs during the 6-month period following randomisation.
there was a non-significant difference between the community hospital and general hospital groups for changes in quality-adjusted life-year values from baseline to 6 months (mean difference 0.048; 95% confidence interval -0.028 to 0.123; P = 0.214). Resource use was similar for both groups. The mean (standard deviation) costs per patient for health and social services resources used were comparable for both groups: community hospital group 8,946 pounds ( 6,514 pounds); general hospital group 8,226 pounds ( 7,453 pounds). These findings were robust to sensitivity analyses. The incremental cost-effectiveness ratio estimate was 16,324 pounds per quality-adjusted life year. A cost effectiveness acceptability curve suggests that if decision makers' willingness to pay per quality-adjusted life year was 10,000 pounds, then community hospital care was effective in 47% of cases, and this increased to only 50% if the threshold willingness to pay was raised to 30,000 pounds.
the cost effectiveness of post-acute rehabilitation for older people was similar in community hospitals and general hospitals.
"Another study of community hospitals shows significantly greater functional independence at six months for patients allocated to one of seven community hospitals . In a complementary cost-effectiveness study, O’Reilly et al. found that the health outcomes and costs between the two services were similar . "
[Show abstract][Hide abstract] ABSTRACT: Different care models have been established to achieve more coordinated clinical pathways for older patients in the transition between hospital and home. This study explores an intermediate unit's role in a clinical pathway for older patients with somatic diseases.
Qualitative data were collected via interviews, observations, and a questionnaire. Participants included patients and healthcare providers within both specialist and primary healthcare. Transcripts of interviews and field notes were analyzed using a method of systematic text condensation.
Healthcare providers in the hospital, the intermediate unit, and the municipalities have different opinions about who is a 'suitable' patient for the unit and what is the proper time for hospital discharge. This results in time-consuming negotiations between the hospital and the unit. Incompatible computer systems increase the healthcare provider's workload. Several informants are doubtful as to whether a stay in the unit is useful to the patients, while the patients are mostly pleased with their stay and the transferral.
This study describes challenges that may occur when a new unit is established in an existing healthcare system in order to achieve an appropriate clinical pathway from hospital to home.
International journal of integrated care 03/2013; 13:e012. · 1.50 Impact Factor
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