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Geriatric medicine
Research
Should I stay or should I go? A retrospective propensity score-matched analysis using administrative data of hospital-at-home for older people in Scotland
  1. Apostolos Tsiachristas1,
  2. Graham Ellis2,
  3. Scott Buchanan3,
  4. Peter Langhorne4,
  5. David J Stott4,
  6. Sasha Shepperd5
  1. 1 Health Economics Research Centre, Nuffield Department of Population Health, University of Oxford, Oxford, UK
  2. 2 Monklands Hospital, NHS Lanarkshire, Airdrie, UK
  3. 3 Information Services Division, National Services Scotland, Edinburgh, UK
  4. 4 Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, UK
  5. 5 Nuffield Department of Population Health, University of Oxford, Oxford, UK
  1. Correspondence to Dr Apostolos Tsiachristas; apostolos.tsiachristas{at}ndph.ox.ac.uk

Abstract

Objectives To compare the characteristics of populations admitted to hospital-at-home services with the population admitted to hospital and assess the association of these services with healthcare costs and mortality.

Design In a retrospective observational cohort study of linked patient level data, we used propensity score matching in combination with regression analysis.

Participants Patients aged 65 years and older admitted to hospital-at-home or hospital.

Interventions Three geriatrician-led admission avoidance hospital-at-home services in Scotland.

Outcome measures Healthcare costs and mortality.

Results Patients in hospital-at-home were older and more socioeconomically disadvantaged, had higher rates of previous hospitalisation and there was a greater proportion of women and people with several chronic conditions compared with the population admitted to hospital. The cost of providing hospital-at-home varied between the three sites from £628 to £2928 per admission. Hospital-at-home was associated with 18% lower costs during the follow-up period in site 1 (ratio of means 0.82; 95% CI: 0.76 to 0.89). Limiting the analysis to costs during the 6 months following index discharge, patients in the hospital-at-home cohorts had 27% higher costs (ratio of means 1.27; 95% CI: 1.14 to 1.41) in site 1, 9% (ratio of means 1.09; 95% CI: 0.95 to 1.24) in site 2 and 70% in site 3 (ratio of means 1.70; 95% CI: 1.40 to 2.07) compared with patients in the control cohorts. Admission to hospital-at-home was associated with an increased risk of death during the follow-up period in all three sites (1.09, 95% CI: 1.00 to 1.19 site 1; 1.29, 95% CI: 1.15 to 1.44 site 2; 1.27, 95% CI: 1.06 to 1.54 site 3).

Conclusions Our findings indicate that in these three cohorts, the populations admitted to hospital-at-home and hospital differ. We cannot rule out the risk of residual confounding, as our analysis relied on an administrative data set and we lacked data on disease severity and type of hospitalised care received in the control cohorts.

  • hospital-at-home
  • admission avoidance
  • intermediate care
  • costs
  • mortality
  • UK

This is an open access article distributed in accordance with the Creative Commons Attribution 4.0 Unported (CC BY 4.0) license, which permits others to copy, redistribute, remix, transform and build upon this work for any purpose, provided the original work is properly cited, a link to the licence is given, and indication of whether changes were made. See: https://creativecommons.org/licenses/by/4.0/.

https://doi.org/10.1136/bmjopen-2018-023350

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    Footnotes

    • Contributors AT, GE and SS were responsible for study concept. GE and SB facilitated the acquisition of data. AT and SS led the writing of the protocol, study design and drafting of the manuscript. AT performed the statistical analysis. PL and DJS provided clinical expertise and commented on previous versions of the manuscript. All authors interpreted the data, critically revised the manuscript for important intellectual content and approved the final version for submission. AT and SS are guarantors.

    • Funding NIHR, UK. (12/5003//01; “How to Implement Cost-Effective Comprehensive Geriatric Assessment”).

    • Competing interests GE is leading one of the hospital-at-home services in this study.

    • Ethics approval We obtained local data transfer agreements and signed release forms from each Health Board’s Caldicott guardian. Further approval from an ethics committee was not required because the study was part of a service audit and the data provided to the researchers were deidentified.

    • Provenance and peer review Not commissioned; externally peer reviewed.

    • Data sharing statement No additional data are available.

    • Patient consent for publication Not required.