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Effectiveness of community hospital post-acute care on mortality, re-admission, institutionalization, and activation of a home care programme in Emilia-Romagna region, Italy

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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.

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Funding

This study received funding from the National Centre for Disease Prevention and Control (CCM)—Ministry of health (grant number 2019 CCM Project-E49E19001040001).

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Correspondence to Elena Berti.

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The authors have no competing interests to declare that are relevant to the content of this article.

Ethical approval and informed consent

We used unidentifiable aggregated data to carry out secondary analyses on information that are already routinely collected for administrative reasons; their use is authorised for routine activities of health service research and quality improvement by regional health authorities and for which individuals' written consent is not required under the current national regulation. Data have been processed following appropriate privacy regulations.

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Di Girolamo, C., Leucci, A.C., Sforza, S. et al. Effectiveness of community hospital post-acute care on mortality, re-admission, institutionalization, and activation of a home care programme in Emilia-Romagna region, Italy. Aging Clin Exp Res 35, 367–374 (2023). https://doi.org/10.1007/s40520-022-02298-3

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  • DOI: https://doi.org/10.1007/s40520-022-02298-3

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