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

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

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

Design Randomised controlled trial.

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

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

Interventions Patients were randomly allocated to a locality based community hospital or to remain within a department for the care of elderly people in a district general hospital.

Main outcome measures Primary outcomes were Nottingham extended activities of daily living scale and general health questionnaire 28 (carer). Secondary outcomes were activities of daily living (Barthel index), Nottingham health profile, hospital anxiety and depression scale, mortality, destination after discharge, satisfaction with services, carer strain index, and carer's satisfaction with services.

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

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

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Rapid Responses:

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Its time to shift the focus away from hospital care

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