Aims
This COVID-19 rapid response service aimed to reduce hospital presentations among older people discharged from the emergency department and short-stay wards at Liverpool Hospital.
Methods
This retrospective cohort study compared 112 patients who completed the Care in the Community (CIC) intervention with 112 randomly selected controls. Both cases and controls were discharged between September 2020 and June 2021. Intervention patients were evaluated by a multidisciplinary team, who implemented a goal-directed program of up to 4-weeks duration. Logistic regression, negative binomial regression, and Cox proportional hazards regression were used to evaluate outcomes at 28 days and at 6 months.
Results
The median time between referral and the first home visit was 3.9 days. The intervention reduced hospital presentations at 28 days (odds ratio 0.42, 95% CI 0.18–0.99), after adjusting for pre-recruitment hospital presentations, living alone, cardiac failure and cognitive impairment. Although the intervention did not reduce the number of hospital presentations at 6 months (adjusted incidence rate ratio 0.73, 95% CI 0.49–1.08), it reduced total time spent in hospital by 303 days (582 versus 885 days). After adjusting for the aforementioned variables, and mobility aid use and chronic airflow limitation, the intervention decreased the probability of the first hospital presentation (hazard ratio 0.65, 95% CI 0.43–0.98).
Conclusion
This study is among the first to investigate the effect of a community-based intervention on hospital presentations during the COVID-19 pandemic. It provides evidence that a sustainable 4-week intervention is associated with reduced hospital presentations and time spent in hospital.