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

Tsiachristas, A., Ellis, G., Buchanan, S., Langhorne, P. , Stott J, D. and Shepperd, S. (2019) 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. BMJ Open, 9, e023350. (doi: 10.1136/bmjopen-2018-023350) (PMID:31072849) (PMCID:PMC6527981)

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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.

Item Type:Articles
Glasgow Author(s) Enlighten ID:Langhorne, Professor Peter and Stott J, Professor David and Ellis, Dr Graham
Authors: Tsiachristas, A., Ellis, G., Buchanan, S., Langhorne, P., Stott J, D., and Shepperd, S.
College/School:College of Medical Veterinary and Life Sciences > School of Cardiovascular & Metabolic Health
Journal Name:BMJ Open
Publisher:BMJ Publishing Group
ISSN (Online):2044-6055
Published Online:09 May 2019
Copyright Holders:Copyright © Authors (or their employers) 2019
First Published:First published in BMJ Open 9:e023350
Publisher Policy:Reproduced under a Creative Commons license

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Project CodeAward NoProject NamePrincipal InvestigatorFunder's NameFunder RefLead Dept
170222How best to deliver comprehensive geriatric assessment (CGA) (12/5003/01)David Stott JNational Institute for Health Research (NIHR)Stott, Prof DavidInstitute of Cardiovascular & Medical Sciences