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Hilland GH, Hagen TP, Martinussen PE. Stayin' alive: The introduction of municipal in-patient acute care units was associated with reduced mortality and fewer hospital readmissions. Soc Sci Med 2023; 326:115912. [PMID: 37104970 DOI: 10.1016/j.socscimed.2023.115912] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2022] [Revised: 02/27/2023] [Accepted: 04/13/2023] [Indexed: 04/29/2023]
Abstract
BACKGROUND Integrated care is seen as integral in combating the current and projected resource scarcity in the healthcare systems of developed economies. Previous research finds positive effects from implementing intermediate care but there is a lack of research on how this shift towards care integration has affected traditional quality indicators within healthcare, indicators such as mortality rates and hospital readmissions. We seek to contribute to the discourse by studying how the introduction of intermediate care in the form of municipal acute units (MAUs) in Norway has affected age adjusted mortality rates and hospital readmissions. DATA AND METHODS In this retrospective cohort study we utilize yearly population-based registry data from 2010 to 2016, analysed with fixed-effects regressions. Data on the implementation, characteristics and localization of the MAUs were gathered by telephone during the implementation period. Data on mortality rates and hospital readmissions were collected from Statistics Norway and the Norwegian patient registry. RESULTS Our analyses finds that the introduction of MAU was associated with a statistically significant reduction in both aggregated mortality rates and hospital readmission rates. In depth analyses finds that our results are contingent upon the age of the patients treated at the MAUs and the clinical characteristics of the medical units themselves. CONCLUSION Our findings indicate that the shift towards intermediate care through the introduction of MAUs has increased performance within the public healthcare sector in Norway. Our findings indicate that the introduction of MAU have had a positive public health impact by lowering the mortality and readmission rates for the oldest population cohort in Norway. Our findings suggests that countries with comparatively similar healthcare systems as Norway could achieve similar benefits from implementing intermediate care in the form of somatic medical institutions in the local communities.
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Affiliation(s)
- Geir Haakon Hilland
- SINTEF Digital, Department of Health, Health Services Research Group, Strindvegen 4, 7034 Trondheim, Norway.
| | - Terje P Hagen
- University of Oslo, Department of Health Management and Health Economics, Problemveien 7, 0315 Oslo, Norway.
| | - Pål E Martinussen
- Norwegian University of Science and Technology, Department of Sociology and Political Science, Edvard Bulls Veg 1, 7491 Trondheim, Norway.
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Davidson D, Ellis Paine A, Glasby J, Williams I, Tucker H, Crilly T, Crilly J, Mesurier NL, Mohan J, Kamerade D, Seamark D, Marriott J. Analysis of the profile, characteristics, patient experience and community value of community hospitals: a multimethod study. HEALTH SERVICES AND DELIVERY RESEARCH 2019. [DOI: 10.3310/hsdr07010] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
BackgroundCommunity hospitals have been part of England’s health-care landscape since the mid-nineteenth century. Evidence on them has not kept pace with their development.AimTo provide a comprehensive analysis of the profile, characteristics, patient experience and community value of community hospitals.DesignA multimethod study with three phases. Phase 1 involved national mapping and the construction of a new database of community hospitals through data set reconciliation and verification. Phase 2 involved nine case studies, including interviews and focus groups with patients (n = 60), carers (n = 28), staff (n = 132), volunteers (n = 68), community stakeholders (n = 74) and managers and commissioners (n = 9). Phase 3 involved analysis of Charity Commission data on voluntary support.SettingCommunity hospitals in England.ResultsThe study identified 296 community hospitals with beds in England. Typically, the hospitals were small (< 30 beds), in rural communities, led by doctors/general practitioners (GPs) and nurses, without 24/7 on-site medical cover and provided step-down and step-up inpatient care, with an average length of stay of < 30 days and a variable range of intermediate care services. Key to patients’ and carers’ experiences of community hospitals was their closeness to ‘home’ through their physical location, environment and atmosphere and the relationships that they support; their provision of personalised, holistic care; and their role in supporting patients through difficult psychological transitions. Communities engage with and support their hospitals through giving time (average 24 volunteers), raising money (median voluntary income £15,632), providing services (voluntary and community groups) and giving voice (e.g. taking part in communication and consultation). This can contribute to hospital utilisation and sustainability, patient experience, staff morale and volunteer well-being. Engagement varies between and within communities and over time. Community hospitals are important community assets, representing direct and indirect value: instrumental (e.g. health care), economic (e.g. employment), human (e.g. skills development), social (e.g. networks), cultural (e.g. identity and belonging) and symbolic (e.g. vitality and security). Value varies depending on place and time.LimitationsThere were limitations to the secondary data available for mapping community hospitals and tracking charitable funds and to the sample of case study respondents, which concentrated on people with a connection to the hospitals.ConclusionsCommunity hospitals are diverse but are united by a set of common characteristics. Patients and carers experience community hospitals as qualitatively different from other settings. Their accounts highlight the importance of considering the functional, interpersonal, social and psychological dimensions of experience. Community hospitals are highly valued by their local communities, as demonstrated through their active involvement as volunteers and donors. Community hospitals enable the provision of local intermediate care services, delivered through an embedded, relational model of care, which generates deep feelings of reassurance. However, current developments may undermine this, including the withdrawal of GPs, shifts towards step-down care for non-local patients and changing configurations of services, providers and ownership.Future workComparative studies of patient experience in different settings; longitudinal studies of community support and value; studies into the implications of changes in community hospital function, GP involvement, provider-mix and ownership; and international comparative studies could all be undertaken.FundingThe National Institute for Health Research Health Services and Delivery Research programme.
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Affiliation(s)
- Deborah Davidson
- School of Social Policy, University of Birmingham, Birmingham, UK
| | | | - Jon Glasby
- School of Social Policy, University of Birmingham, Birmingham, UK
| | - Iestyn Williams
- School of Social Policy, University of Birmingham, Birmingham, UK
| | - Helen Tucker
- Helen Tucker Associates Ltd, Newport, Shropshire, UK
| | | | | | - Nick Le Mesurier
- School of Social Policy, University of Birmingham, Birmingham, UK
| | - John Mohan
- School of Social Policy, University of Birmingham, Birmingham, UK
| | - Daiga Kamerade
- School of Health and Society, University of Salford, Salford, UK
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Schmidt AK, Lilleeng B, Baste V, Mildestvedt T, Ruths S. First four years of operation of a municipal acute bed unit in rural Norway. Scand J Prim Health Care 2018; 36:390-396. [PMID: 30289320 PMCID: PMC6381517 DOI: 10.1080/02813432.2018.1523993] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVE To evaluate the use of a small municipality acute bed unit (MAU) in rural Norway resulting from the Coordination reform regarding occupancy-rate, patient characteristics and healthcare provided during the first four years of operation. Further, to investigate whether implementation of the new municipal service avoided acute hospital admissions. DESIGN Observational study. SETTING A two-bed municipal acute bed unit. SUBJECTS All patients admitted to the unit between 2013 and 2016. MAIN OUTCOME MEASURES Demographics, comorbidity, main diagnoses and level of municipal care on admission and discharge, diagnostic and therapeutic initiatives, MAU occupancy rate, and acute hospital admission rate. RESULTS Altogether, 389 admissions occurred, 215 first-time admissions and 174 readmissions. The mean MAU bed occupancy rate doubled from of 0.26 in 2013 to 0.50 in 2016, while acute hospital admission rates declined. The patients (median age 84.0 years, 48.9% women at first time admission) were most commonly admitted for infections (28.0%), observation (22.1%) or musculoskeletal symptoms (16.2%). Some 52.7% of the patients admitted from home were discharged to a higher care level; musculoskeletal problems as admission diagnosis predicted this (RR =1.43, 95% CI 1.20-1.71, adjusted for age and sex). CONCLUSION Admission rates to MAU increased during the first years of operation. In the same period, there was a reduction in acute hospital admissions. Patient selection was largely in accordance with national and local criteria, including observational stays. Half the patients admitted from home were discharged to nursing home, suggesting that the unit was used as pathway to a higher municipal care level. Key Points Evaluation of the first four years of operation of a municipality acute bed unit (MAU) in rural Norway revealed: • Admission rates to MAU increased, timely coinciding with decreased acute admission rates to hospital medical wards. • Most patients were old and had complex health problems. • Only half the patients were discharged back home; musculoskeletal symptoms were associated with discharge to a higher care level.
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Affiliation(s)
- Anne Kjær Schmidt
- Research Unit for General Practice, Uni Research Health, Bergen, Norway;
- Luster Legekontor, Luster, Norway;
| | | | | | - Thomas Mildestvedt
- Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
| | - Sabine Ruths
- Research Unit for General Practice, Uni Research Health, Bergen, Norway;
- Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
- CONTACT Sabine Ruths Research Unit for General Practice, Uni Research Health, P. O. Box 7804, N-5020Bergen, Norway
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Abstract
OBJECTIVE The Coordination reform was implemented in Norway from 2012, aiming at seamless patient trajectories. All municipalities are required to establish emergency care beds (MEBs) to avoid unnecessary hospital admissions. We aimed to examine occupancy rate, patient characteristics, diagnoses and discharge level of municipal care in a small MEB unit. DESIGN Cross-sectional, observational study. SETTING A two-bed emergency care unit. SUBJECTS All patients admitted to the unit during one year. MAIN OUTCOME MEASURES Patients' age and gender, comorbidity, main diagnoses and municipal care level on admission and discharge, diagnostic and therapeutic initiatives, occupancy rate. RESULTS Sixty admissions were registered, with total bed occupancy 194 days, and an occupancy rate of 0.27. The patients (median age 83 years, 57% women) had mostly infections, musculoskeletal symptoms or undefined conditions. Some 48% of the stays exceeded three days and 43% of the patients were subsequently transferred to nursing homes or hospitals. CONCLUSION Occupancy rate was low. Patient selection was not according to national standards, and stays were longer. Many patients were transferred to nursing homes, indicating that the unit was an intermediate pathway or a short cut to institutional care. It is unclear whether the unit avoided hospital admissions.
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Affiliation(s)
- Heidi Nilsen
- Research Unit for General Practice, Uni Research Health, Bergen, Norway
| | - Steinar Hunskaar
- Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
- National Centre for Emergency Primary Health Care, Uni Research Health, Bergen, Norway
| | - Sabine Ruths
- Research Unit for General Practice, Uni Research Health, Bergen, Norway
- Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
- CONTACT Sabine Ruths Research Unit for General Practice, Uni Research Health, PO Box 7804, N-5020 Bergen, Norway
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Ford KL, Bryant AN, Kim G. Age differences in satisfaction with and perceived benefit from mental health services: results from the collaborative psychiatric epidemiology surveys. Int J Geriatr Psychiatry 2013; 28:831-40. [PMID: 23044699 DOI: 10.1002/gps.3889] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/02/2012] [Accepted: 09/07/2012] [Indexed: 11/09/2022]
Abstract
OBJECTIVE This study examined variation by age in satisfaction with and perceived benefit from mental health services (MHS). METHODS Drawn from the nationally representative Collaborative Psychiatric Epidemiology Surveys (2001-2003), the current sample included 1286 adults from age 18 to 87 years who had at least one DSM-IV diagnosis and had used MHS during the past year. Multiple linear regression analyses were used to predict satisfaction with and perceived benefit from past year MHS use. Independent variables were sociodemographic factors and objective and perceived needs. RESULTS Results from multiple linear regression analyses showed that older age was positively associated with both MHS satisfaction (p < 0.05, β = 0.105) and perceived amount of benefit (p < 0.05, β = 0.106), as was better self-rated mental health (p < 0.001, β = 0.186; p < 0.001, β = 0.177). A greater number of comorbid psychiatric diagnoses was negatively associated with satisfaction (p < 0.05, β = -0.089). Marital status was found to be a moderator of the effect of age: for married respondents, age had a significant effect on both outcome variables (p < 0.05, β = 0.102; p < 0.05, β = 0.105), but for unmarried respondents, it did not. CONCLUSIONS Our findings show clear evidence of age differences in satisfaction with and perceived benefit from MHS. The findings provide important implications for future interventions targeted to improve MHS satisfaction. Age-specific strategies should be developed to prevent delay in mental health treatment.
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Affiliation(s)
- Katy L Ford
- Department of Psychology, University of Alabama, Tuscaloosa, AL, USA.
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O' Donnell H, Gormley K. Service user involvement in nurse education: perceptions of mental health nursing students. J Psychiatr Ment Health Nurs 2013; 20:193-202. [PMID: 22533371 DOI: 10.1111/j.1365-2850.2012.01917.x] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Increasingly providers of mental health nurse education are required to demonstrate user involvement in all aspects of these programmes including student selection, programme design and student assessment. There has been limited analysis of how nursing students perceive user involvement in nurse education programmes. The aim of this study has been to explore mental health nursing student's perceptions of involving users in all aspects of pre-registration mental health nursing programme. Researchers completed a number of focus group interviews with 12 ex-mental health nursing students who had been recruited by purposeful sampling. Each focus group interview was recorded and analysed using a series of data reduction, data display and verification methods. The study confirms many of the findings reported in earlier user participation in education studies. Three main themes related to user involvement have been identified: the protection of users, enhanced student learning and the added value benefits associated with user involvement.
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Affiliation(s)
- H O' Donnell
- School of Nursing and Midwifery, Queens University, Belfast, Medical Biology Centre, Belfast, UK.
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Johansen I, Lindbaek M, Stanghelle JK, Brekke M. Structured community-based inpatient rehabilitation of older patients is better than standard primary health care rehabilitation – an open comparative study. Disabil Rehabil 2012; 34:2039-46. [DOI: 10.3109/09638288.2012.667193] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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The challenge of validating SF-12 for its use with community-dwelling elderly in Israel. Qual Life Res 2009; 19:91-5. [DOI: 10.1007/s11136-009-9562-3] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/16/2009] [Indexed: 10/20/2022]
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Ward D, Drahota A, Gal D, Severs M, Dean TP. Care home versus hospital and own home environments for rehabilitation of older people. Cochrane Database Syst Rev 2008; 2008:CD003164. [PMID: 18843641 PMCID: PMC6991934 DOI: 10.1002/14651858.cd003164.pub2] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
BACKGROUND Rehabilitation for older people has acquired an increasingly important profile for both policy-makers and service providers within health and social care agencies. This has generated an increased interest in the use of alternative care environments including care home environments. Yet, there appears to be limited evidence on which to base decisions.This review is the first update of the Cochrane review which was published in 2003. OBJECTIVES To compare the effects of care home environments (e.g. nursing home, residential care home and nursing facilities) versus hospital environments and own home environments in the rehabilitation of older people. SEARCH STRATEGY We searched the Cochrane Effective Practice and Organisation of Care Specialised Register and Pending Folder, MEDLINE (1950 to March Week 3 2007), EMBASE (1980 to 2007 Week 13), CINAHL (1982 to March, Week 4, 2007), other databases and reference lists of relevant review articles were additionally reviewed. Date of most recent search: March 2007. SELECTION CRITERIA Randomised controlled trials (RCTs), controlled clinical trials (CCTs), controlled before and after studies (CBAs) and interrupted time series (ITS) that compared rehabilitation outcomes for persons 60 years or older who received rehabilitation whilst residing in a care home with those who received rehabilitation in hospital or own home environments. DATA COLLECTION AND ANALYSIS Two review authors independently assessed trial quality and extracted data. MAIN RESULTS In this update, 8365 references were retrieved. Of these, 339 abstracts were independently assessed by 2 review authors, and 56 studies and 5 review articles were subsequently obtained. Full text papers were independently assessed by two or three review authors and none of these met inclusion criteria. AUTHORS' CONCLUSIONS There is insufficient evidence to compare the effects of care home environments versus hospital environments or own home environments on older persons rehabilitation outcomes. Although the authors acknowledge that absence of effect is not no effect. There are three main reasons; the first is that the description and specification of the environment is often not clear; secondly, the components of the rehabilitation system within the given environments are not adequately specified and; thirdly, when the components are clearly specified they demonstrate that the control and intervention sites are not comparable with respect to the methodological criteria specified by Cochrane EPOC group. The combined effect of these factors resulted in the comparability between intervention and control groups being very weak.
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Affiliation(s)
- Derek Ward
- Bursledon Infants SchoolHampshire County CouncilLong LaneBursledonHampshireUK
| | - Amy Drahota
- National Institute for Health ResearchUK Cochrane CentreSummertown Pavilion, Middle WayOxfordOxfordshireUKOX2 7LG
| | - Diane Gal
- University of PortsmouthSchool of Health Sciences & Social WorkJames Watson West2 King Richard 1st RoadPortsmouthUKPO2 1FR
| | - Martin Severs
- University of PortsmouthSchool of Health Sciences & Social WorkJames Watson West2 King Richard 1st RoadPortsmouthUKPO2 1FR
| | - Taraneh P Dean
- University of PortsmouthSchool of Health Sciences & Social WorkJames Watson West2 King Richard 1st RoadPortsmouthUKPO2 1FR
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Abstract
Although intermediate care takes a variety of different forms and has developed somewhat differently in different countries, we believe that intermediate-care schemes have enough in common to make it meaningful to examine the relationship between this method of care and the views of older patients receiving either it or its alternatives. This is particularly important as one of the underlying principles of intermediate care is to extend patient choice; furthermore, most intermediate-care services target older people. In this review we examine evidence about whether older people prefer intermediate or hospital care, and what they like and dislike about intermediate care.
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Wetzels R, Harmsen M, Van Weel C, Grol R, Wensing M. Interventions for improving older patients' involvement in primary care episodes. Cochrane Database Syst Rev 2007; 2007:CD004273. [PMID: 17253501 PMCID: PMC7197439 DOI: 10.1002/14651858.cd004273.pub2] [Citation(s) in RCA: 42] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
BACKGROUND There is a growing expectation among patients that they should be involved in the delivery of medical care. Accumulating evidence from empirical studies shows that patients of average age who are encouraged to participate more actively in treatment decisions have more favourable health outcomes, in terms of both physiological and functional status, than those who do not. Interventions to encourage more active participation may be focused on different stages, including: the use of health care; preparation for contact with a care provider; contact with the care provider; or feedback about care. However, it is unclear whether the benefits of these interventions apply to the elderly as well. OBJECTIVES To assess the effects of interventions in primary medical care that improve the involvement of older patients (>=65 years) in their health care. SEARCH STRATEGY We searched: the Cochrane Consumers and Communication Review Group Specialised Register (May 2003); the Cochrane Central Register of Controlled Trials (CENTRAL), The Cochrane Library issue 1, 2004; MEDLINE (Ovid) (1966 to June 2004); EMBASE (1988 to June 2004); PsycINFO (1872 to June 2004); DARE, The Cochrane Library issue 1, 2004; ERIC (1966 to June 2004); CINAHL (1982 to June 2004); Sociological Abstracts (1963 to June 2004); Dissertation Abstracts International (1861 to June 2004); and reference lists of articles. SELECTION CRITERIA Randomised controlled trials or quasi-randomised trials of interventions to improve the involvement of older patients (>= 65 years) in single consultations or episodes of primary medical care. DATA COLLECTION AND ANALYSIS Two review authors independently assessed trial quality and extracted data. Results are presented narratively as meta-analysis was not possible. MAIN RESULTS We identified three studies involving 433 patients. Overall, the quality of studies was not high, and there was moderate to high risk of bias. Interventions of a pre-visit booklet and a pre-visit session (either combined or pre-visit session alone) led to more questioning behaviour and more self-reported active behaviour in the intervention group (3 studies). One study (booklet and pre-visit session) showed no difference in consultation length and time engaged in talk between the intervention and control groups. The booklet and pre-visit session in one study was associated with more satisfaction with interpersonal aspects of care for the intervention group although no difference in overall satisfaction between intervention and control. There was no long-term follow up to see if effects were sustained. No studies measured outcomes relating to the use of health care, health status and wellbeing, or health behaviour. AUTHORS' CONCLUSIONS Overall this review shows some positive effects of specific methods to improve the involvement of older people in primary care episodes. Because the evidence is limited, however, we can not recommend the use of the reviewed interventions in daily practice. There should be a balance between respecting patients' autonomy and stimulating their active participation in health care. Face-to-face coaching sessions, whether or not complemented with written materials, may be the way forward. As this is impractical for the whole population, it could be worthwhile to identify a subgroup of older patients who might benefit the most from enhanced involvement, ie. those who want to be involved, but lack the necessary skills. This group could be coached either individually or, more practically, in group sessions.
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Affiliation(s)
- R Wetzels
- Radboud University Nijmegen Medical Centre, Centre for Quality of Care Research (WOK), (117 KWAZO), PO Box 9101, Nijmegen, Netherlands, 6500 HB.
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Hakkaart-van Roijen L, Moll van Charante EP, Bindels PJE, Yzermans CJ, Rutten FFH. A cost study of a general practitioner hospital in the Netherlands. Eur J Gen Pract 2004; 10:45-9. [PMID: 15232523 DOI: 10.3109/13814780409094231] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVE To perform a cost study of the first general practitioner (GP) hospital in the Netherlands. METHODS We conducted a cost study in a GP hospital in the Netherlands. Data on healthcare utilisation from 218 patients were collected for a period of one year. The costs of admission to the GP hospital were compared with the expected costs of the alternative mode of care. In the GP hospital three types of bed categories were distinguished: GP beds (admission and discharge by GPs, n=131), rehabilitation beds (recovery from hospital surgery, n=62) and nursing home beds (hospital patients awaiting a vacancy in a nursing home, n=25). GPs were interviewed to indicate the best alternative form of healthcare for the GP bed patients in the absence of a GP hospital (dichotomised for this study into "hospital" or "home care"). For the "rehabilitation" and "nursing home" patients the alternative care mode was admission to a hospital. RESULTS The mean length of stay was 15 days for the GP beds, 31 days for the rehabilitation beds and 90 days for the nursing home beds. For the GP bed patients the costs were 2533 euros per admission compared with 3792 euros for hospital stay. For the group of GP bed patients for whom "home care" was the best alternative, the costs were 2494 euros for GP hospital days compared with 2814euros , the average cost for home care of patients of 65 years and older. For rehabilitation patients the costs per patient were 4744 euros compared with 8041 euros in a hospital. For patients waiting for admission to a nursing home, these costs were 13,143 euros and 22,670 euros respectively. CONCLUSION The GP hospital might be a cost-saving alternative for elderly patients in need of intermediate medical and nursing care between hospital and home care. Further research on the cost-effectiveness of the GP hospital compared with home care and nursing home care is needed.
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Abstract
Apparently simple questions can easily be misunderstood or cause offence in disadvantaged groups. But such problems can be avoided by careful design, piloting, and administration
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Affiliation(s)
- Petra M Boynton
- Department of Primary Care and Population Sciences, University College London, London N19 5LW.
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