Effects of locality based community hospital care on independence in older people needing rehabilitation: randomised controlled trial

doi:10.1136/bmj.38498.387569.8F

BMJ 2005;331:317-322 (6 August), doi:10.1136/bmj.38498.387569.8F (published 1 July 2005)

Paper

Effects of locality based community hospital care on independence in older people needing rehabilitation: randomised controlled trial

John Green, research fellow¹, John Young, consultant geriatrician¹, Anne Forster, principal research fellow¹, Karen Mallinder, research nurse¹, Sue Bogle, consultant statistician², Karin Lowson, project director³, Neil Small, professor of health research⁴

¹ Department of Health Care for the Elderly, St Luke's Hospital, Bradford BD5 0NA, ² Aysgarth Statistics, Beaconsfield HP9 2AS, ³ York Health Economics Consortium, University of York, York YO10 5NH, ⁴ School of Health Studies, University of Bradford, Bradford BD5 0BB

Correspondence to: J Green becarrd.1{at}bradfordhospitals.nhs.uk

Objective To determine the effects on independence in olderpeople needing rehabilitation in a locality based communityhospital compared with care on a ward for elderly people ina district general hospital.

Design Randomised controlled trial.

Setting Care in a community hospital and district general hospitalin Bradford, England.

Participants 220 patients needing rehabilitation after an acuteillness that required hospital admission.

Interventions Patients were randomly allocated to a localitybased community hospital or to remain within a department forthe care of elderly people in a district general hospital.

Main outcome measures Primary outcomes were Nottingham extendedactivities of daily living scale and general health questionnaire28 (carer). Secondary outcomes were activities of daily living(Barthel index), Nottingham health profile, hospital anxietyand depression scale, mortality, destination after discharge,satisfaction with services, carer strain index, and carer'ssatisfaction with services.

Results The median length of stay was 15 days for both the communityhospital and the district general hospital groups (interquartilerange: community hospital 9-25 days; district general hospital9-24 days). Independence at six months was greater in the communityhospital group (adjusted mean difference 5.30, 95% confidenceinterval 0.64 to 9.96). Results for the secondary outcome measures,including care satisfaction and measures of carer burden, weresimilar for both groups.

Conclusions Care in a locality based community hospital is associatedwith greater independence for older people than care in wardsfor elderly people in a district general hospital.

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Rapid Responses:

Read all Rapid Responses

Its time to shift the focus away from hospital care: Raghu S Raju
bmj.com, 7 Jul 2005 [Full text]
greater demand of beds and staff in community hospitals.: Sudhendra Prabhu
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Comparable staffing?: Kalman M Kafetz
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