Abstract
BackgroundAmbulatory geriatric rehabilitation (AGR) is a community based outpatient intervention which aims to improve physical function, maintain independent living of geriatric patients, avoiding hospitalisation and institutionalisation. It should therefore reduce health care costs. The objective of our study is to evaluate the effectiveness of AGR for frail elderly patients insured by the statutory health insurance AOK Nordost compared to care as usual. Outcome variables are progression to higher nursing care levels, admission to nursing home, incident fractures, hospital admission, ambulatory care sensitive hospital admissions, days spent in hospital, and health care costs.MethodsThis matched cohort study aims to estimate average treatment effects of AGR. For this purpose we will compare patients receiving AGR with matched patients receiving care as usual. Patients in the intervention group were treated between the years 2009 and 2013 from three centres in Mecklenburg-Vorpommern, Germany. Matching will be conducted using propensity score techniques. Claims data will be provided by the statutory health insurance AOK Nordost. The primary outcomes are the progression of nursing care levels, incident fractures, and admission to nursing home. Secondary outcomes are total and ambulatory care sensitive hospital admissions, and health care costs from the statutory health insurance perspective. Data will be analysed using appropriate regression models.DiscussionThis study aims to quantify the effectiveness of AGR. Results will be important for providers of AGR, policy makers and stakeholders to make informed decisions on whether to continue, modify or extend AGR.Trial registrationGerman Clinical Trials Register (DRKS) S00008926, registered 29.07.2015
Highlights
Ambulatory geriatric rehabilitation (AGR) is a community based outpatient intervention which aims to improve physical function, maintain independent living of geriatric patients, avoiding hospitalisation and institutionalisation
The aim of our study is to evaluate the effectiveness of AGR regarding patient’s progression to higher nursing care levels, incident fractures, admission to nursing home, hospital admissions as well as health care costs
Anonymised data will be provided by the statutory health insurance AOK Nordost which comprises basic demographic data, data on nursing care level, admission to a nursing home, billing data for ambulatory services (EBM position numbers) and for hospital services (DRG-codes/OPS-codes), as well as diagnoses (ICD-10 codes), and all health care costs, including costs for hospitalisation, remedies and aids, ambulatory costs and costs for medication
Summary
Ambulatory geriatric rehabilitation (AGR) is a community based outpatient intervention which aims to improve physical function, maintain independent living of geriatric patients, avoiding hospitalisation and institutionalisation. Many elderly will experience a reduction in physical function, leading to more falls and injuries This leads to a loss of independence, hospitalisation, long-term nursing home. The increased need of long term nursing care poses a major economic challenge [7]. Patients with a need for rehabilitation prefer to stay close to their home and relatives, maintaining their everyday life [10]. Rehabilitative services were and are still mainly available after hospitalisation e.g. for stroke or fracture after a fall
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