Abstract
BackgroundAmbulatory geriatric rehabilitation (AGR) is a multidisciplinary outpatient prevention program designed to decrease hospitalisation and dependence on nursing care in multimorbid patients ≥70 years of age. We evaluated the effectiveness of AGR compared to usual care on progression of nursing care levels, nursing home admissions, hospital admissions, incident fractures, mortality rate and total cost of care during a one-year follow-up period.MethodsAnalyses were based on claims data from the health insurance company AOK Nordost. Propensity Score matching was used to match 4 controls to each person receiving the AGR intervention.ResultsA total of 632 AGR participants and 2528 matched controls were included. The standardized mean difference of matching variables between cases and controls was small (mean: + 1.4%; range: − 4.4/3.9%). In AGR patients, the progression of nursing care levels (+ 2.2%, 95%CI: − 0.9 /5.3), nursing home admissions (+ 1.7%, 95%CI: − 0.1/3.5), hospital admissions (+ 1.1%, 95%CI: − 3.2/5.4), incident fractures (+ 11.1%, 95%CI: 7.3/15) and mortality rate (+ 1.2%, p = 0.20) showed a less favourable course compared to controls. The average total cost per AGR participant was lower than in the control group (− 353€, 95%CI: − 989€/282€), not including costs for AGR.ConclusionsAnalysis based on claims data showed no clinical benefit from AGR intervention regarding the investigated outcomes. The slightly worse outcomes may reflect limitations in matching based on claims data, which may have insufficiently reflected morbidity and psychosocial factors. It is possible that the intervention group had poorer health status at baseline compared to the control group.Trial registrationGerman Clinical Trials Register DRKS00008926, registered 29.07.2015.
Highlights
Ambulatory geriatric rehabilitation (AGR) is a multidisciplinary outpatient prevention program designed to decrease hospitalisation and dependence on nursing care in multimorbid patients ≥70 years of age
A total of 699 geriatric patients participated in AGR during the observation period between 2009 and 2013 (mean age 79 years (SD ± 5), 72% women)
Out of a pool of 251,000 insured individuals, 2528 controls were matched to 632 AGR participants
Summary
Ambulatory geriatric rehabilitation (AGR) is a multidisciplinary outpatient prevention program designed to decrease hospitalisation and dependence on nursing care in multimorbid patients ≥70 years of age. Frail patients have an increased risk for hospitalisation and dependence on nursing care. Kiel et al BMC Geriatrics (2020) 20:30 hospitalisation and dependence on nursing care in multimorbid patients aged ≥70 years. AGR aims to strengthen and stabilise the physical and cognitive status of frail geriatric patients, enabling them to maintain independent living and to avoid or delay hospitalisation and dependence on nursing care. An alternative to AGR is a mobile rehabilitation program offered to patients in their homes, but this is only available on a regional basis and has not been evaluated by a controlled study design [4]. Because randomised controlled trials evaluating geriatric rehabilitation in the outpatient setting are logistically and ethically difficult to realize, we conducted a matched cohort study based on claims data
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