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

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.

Automated summary

This study aimed to evaluate the impact of transferring patients to Community Hospitals (CHs) on mortality, re-admission, institutionalization, and activation of a home care program in the Emilia-Romagna Region (Italy) after acute hospitalization. The findings showed that patients transferred to CHs had a lower risk of dying but an increased risk of readmission. The risk of institutionalization was lower in the CH exposed group, except for patients with certain chronic diseases. The activation of a home care program was slightly higher for those transferred to a CH.