Intermediate care in nursing home after hospital admission: a randomized controlled trial with one year follow-up

BMC Research Notes

Anette Hylen Ranhoff³  Håkon Ersland¹  Torhild Heggestad¹  Jo Kåre Herfjord² 

[1] Haukeland University Hospital, Jonas Lies vei 63, 5021 Bergen, Norway;County Governor of Hordaland, Postboks 73105020 Bergen, Norway;Department of Clinical Science, University of Bergen and Kavli Research Centre for Geriatrics and Dementia, Haraldsplass Hospital, Ulriksdal 8, 5009 Bergen, Norway

关键词: Randomized controlled trial;    Older people;    Elderly;    Intermediate care;    Community services;    Acute care;   

Others  :  1092414
DOI  :  10.1186/1756-0500-7-889

 received in 2014-03-03, accepted in 2014-11-28,  发布年份 2014

【 摘 要 】

Background

Intermediate care is intended to reduce hospital admissions and facilitate early discharge. In Norway, a model was developed with transfer to intermediate care shortly after hospital admission. Efficacy and safety of this model have not been studied previously.

In a parallel-group randomized controlled trial, patients over 70 years living at home before admission were eligible if clinically stable, without need for surgical treatment and deemed suited for intermediate care by attending physician. Intervention group patients were transferred to a nursing home unit with increased staff and multidisciplinary assessment, for a maximum stay of three weeks. Patients in the control group received usual care in hospital. Blinding to group assignment was not possible.

The primary outcome was number of days living at home in a follow-up period of 365 days. Secondary outcomes were mortality, hospital admissions, need for residential care and home care services. Data were obtained from patient records and registers.

Results

376 patients were included, 74 % female and mean age 84 years. There was no significant differences between intervention (n = 190) and control group (n = 186) for number of days living at home (253.7 vs 256.5, p = 0.80) or days in hospital (10.4 vs 10.5, p = 0.748). Intervention group patients spent less time in nursing home (40.6 days vs. 55.0, p = 0.046), and more patients lived independently without home health care services (31.6 % vs 19.9 %, p = 0.007).

For orthopaedic patients (n = 128), mortality was higher in the intervention group; 15 intervention patients and 7 controls died (25.1 % vs 10.3 %, p = 0.049). There was no significant difference in one-year mortality for medical patients (n = 150) or the total study population.

Conclusions

This model of rapid transfer to intermediate care did not significantly influence number of days living at home during one year follow-up, but reduced demand for nursing home care and need for home health care services. In post-hoc analysis mortality was increased for orthopedic patients.

Trial registration

The trial was registered 26. July 2013 at Current Controlled Trials and assigned with registration number ISRCTN21608185.

【 授权许可】

   
2014 Herfjord et al.; licensee BioMed Central Ltd.

【 图 表 】

Figure 1.

Figure 2.

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