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

BMJ 2005; 331 doi: https://doi.org/10.1136/bmj.38498.387569.8F (Published 04 August 2005) Cite this as: BMJ 2005;331:317
  1. John Green, research fellow (becarrd.1{at}bradfordhospitals.nhs.uk)1,
  2. John Young, consultant geriatrician1,
  3. Anne Forster, principal research fellow1,
  4. Karen Mallinder, research nurse1,
  5. Sue Bogle, consultant statistician2,
  6. Karin Lowson, project director3,
  7. Neil Small, professor of health research4
  1. 1 Department of Health Care for the Elderly, St Luke's Hospital, Bradford BD5 0NA
  2. 2 Aysgarth Statistics, Beaconsfield HP9 2AS
  3. 3 York Health Economics Consortium, University of York, York YO10 5NH
  4. 4 School of Health Studies, University of Bradford, Bradford BD5 0BB
  1. Correspondence to: J Green
  • Accepted 15 May 2005

Abstract

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.

Footnotes

  • Contributors JG managed the study and was involved in data collection, collation and analysis, drafting the paper, and intellectual content. JY conceived the study, obtained funding, and was responsible for the design, initiation, and overall coordination of the study, analysis and interpretation of data, drafting the paper, and intellectual content; he is guarantor for the paper. AF obtained funding and was responsible for the design, initiation, and overall coordination of the study, interpretation of data, drafting the paper, and intellectual content. KM was involved in the initiation of the study, recruited patients, and was involved in writing the paper and its intellectual content. SB provided statistical input to the design of data analysis and interpretation of data and was involved in writing the paper and its intellectual content. KL contributed to the study design, obtained funding, and was responsible for the health economic component of the study. NS contributed to the study design, obtained funding, and was responsible for the qualitative components of the study.

  • Funding Health Foundation.

  • Competing interests JY and JG have worked in the community hospital involved in this study.

  • Ethical approval Bradford Hospitals NHS Foundation Trust research ethics committee

  • Accepted 15 May 2005
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