Table 1
Characteristics of the 2329 study patients, overall and by community hospital, Emilia-Romagna, year 2017.
| COMMUNITY HOSPITAL | PATIENTS | % FEMALE | MEAN AGE | MEAN BARTHEL SCORE AT ADM. | % HIP FRACTURES | AVG. NUMBER OF CONDITIONS | % ADM. FROM ACUTE HOSPITAL | |
|---|---|---|---|---|---|---|---|---|
| N | % | |||||||
| 1 | 465 | 20.0 | 66.5 | 81.4 | 18.7 | 35.7 | 2.0 | 92.9 |
| 2 | 70 | 3.0 | 65.7 | 83.1 | 31.7 | 0.0 | 2.0 | 0.0 |
| 3 | 24 | 1.0 | 70.8 | 84.7 | 38.1 | 4.2 | 1.7 | 37.5 |
| 4 | 298 | 12.8 | 63.1 | 83.9 | 20.4 | 31.2 | 2.6 | 96.0 |
| 5 | 177 | 7.6 | 61.6 | 80.6 | 23.1 | 14.7 | 1.8 | 68.9 |
| 6 | 201 | 8.6 | 65.2 | 81.9 | 32.1 | 18.4 | 2.0 | 63.2 |
| 7 | 123 | 5.3 | 54.5 | 83.7 | 37.2 | 4.9 | 3.5 | 53.7 |
| 8 | 96 | 4.1 | 64.6 | 81.9 | 40.5 | 3.1 | 1.6 | 46.9 |
| 9 | 33 | 1.4 | 66.7 | 84.4 | 47.9 | 0.0 | 1.9 | 21.2 |
| 10 | 131 | 5.6 | 67.2 | 83.2 | 29.8 | 17.6 | 2.1 | 53.4 |
| 11 | 176 | 7.6 | 63.1 | 82.2 | 33.2 | 35.8 | 2.3 | 90.9 |
| 12 | 119 | 5.1 | 49.6 | 81.7 | 23.2 | 12.6 | 3.2 | 95.8 |
| 13 | 416 | 17.9 | 53.6 | 82.7 | 51.8 | 1.7 | 1.9 | 100.0 |
| All | 2329 | 100.0 | 61.5 | 82.4 | 31.1 | 18.9 | 2.2 | 79.6 |
Table 2
Rates of Barthel scoring improvement ≥10, transfer to acute care hospital, and length of stay ≥20 days in 13 community hospitals of Emilia-Romagna, year 2017.
| COMMUNITY HOSPITAL | BARTHEL SCORING IMPROVEMENT ≥ 10 | TRANSFER TO ACUTE CARE HOSPITAL | LENGTH OF STAY ≥ 20 DAYS | |||
|---|---|---|---|---|---|---|
| N | % | N | % | N | % | |
| 1 | 340 | 73.3 | 43 | 9.2 | 158 | 34.0 |
| 2 | 3 | 4.5 | 8 | 11.4 | 49 | 70.0 |
| 3 | 5 | 23.8 | 6 | 25.0 | 14 | 58.3 |
| 4 | 196 | 66.0 | 28 | 9.4 | 155 | 52.0 |
| 5 | 79 | 45.7 | 15 | 8.5 | 94 | 53.1 |
| 6 | 124 | 63.3 | 20 | 10.0 | 139 | 69.2 |
| 7 | 43 | 38.4 | 34 | 27.6 | 67 | 54.5 |
| 8 | 57 | 64.8 | 20 | 20.8 | 54 | 56.3 |
| 9 | 5 | 15.6 | 3 | 9.1 | 16 | 48.5 |
| 10 | 67 | 55.4 | 14 | 10.7 | 85 | 64.9 |
| 11 | 116 | 67.4 | 22 | 12.5 | 99 | 56.3 |
| 12 | 38 | 32.8 | 16 | 13.4 | 53 | 44.5 |
| 13 | 175 | 48.7 | 33 | 7.9 | 66 | 15.9 |
| All | 1248 | 56.3 | 262 | 11.2 | 1049 | 45.0 |
Table 3
Results from Bayesian multilevel logistic regression analysis: association of patient case mix with the study outcomes, Emilia-Romagna, year 2017. Odds ratio (OR) estimate is not available (—) if the patient-level predictor was discarded in preliminary automated regression analyses; clinical conditions not shown in the table were also discarded in preliminary analyses.
| PREDICTOR | BARTHEL SCORING IMPROVEMENT ≥10 | TRANSFER TO ACUTE CARE HOSPITAL | LENGTH OF STAY ≥20 DAYS | ||||
|---|---|---|---|---|---|---|---|
| POSTERIOR OR | 95% CRED. INTERVAL | POSTERIOR OR | 95% CRED. INTERVAL | POSTERIOR OR | 95% CRED. INTERVAL | ||
| Sex (female vs. male) | 1.15 | 0.94–1.40 | 0.83 | 0.63–1.09 | 1.30* | 1.07–1.55 | |
| Age (1-year increase) | 0.95* | 0.94–0.96 | 0.99 | 0.97–1.003 | 0.99 | 0.98–1.01 | |
| Barthel score at admission (1-point increase) | 1.02* | 1.01–1.02 | 0.99* | 0.98–0.995 | 0.99* | 0.986–0.993 | |
| Squared-Barthel score at admission (1-point increase) | 0.999* | 0.999–0.999 | — | — | |||
| Hip fracture | 1.65* | 1.24–2.16 | 0.70 | 0.45–1.01 | 1.42* | 1.09–1.78 | |
| Chronic kidney disease | — | 1.90* | 1.28–2.70 | — | |||
| Metastatic cancer | 0.45* | 0.22–0.83 | — | — | |||
| Cerebrovascular diseases | 0.69* | 0.54–0.86 | — | 1.45* | 1.16–1.80 | ||
| Dementia | 0.61* | 0.47–0.79 | — | — | |||
| Admission source (hospital vs.home/residential facility) | 1.46* | 1.08–1.93 | — | — | |||
| Variance Partition Coefficient (VPC) | 0.271 | 0.062 | 0.147 | ||||
[i] * Significant at the 5% level.
Figure 1
Results from Bayesian multilevel logistic regression models for (a) Barthel scoring improvement ≥10 points, (b) transfer to acute care hospital, and (c) length of stay ≥20 days: CH-specific odds ratios (ORs), unadjusted and adjusted for patient case mix, Emilia-Romagna, year 2017. Dashed line indicates the null value of 1 (no difference compared to the overall average).
Note: Posterior ORs of Barthel scoring improvement were adjusted for sex, age, squared Barthel score on admission, hip fracture, metastatic cancer, cerebrovascular diseases, dementia, and admission source. Posterior ORs of transfer to acute care were adjusted for sex, age, Barthel score on admission, hip fracture, and chronic kidney disease. Posterior ORs of longer period of care were adjusted for sex, age, Barthel score on admission, hip fracture, and cerebrovascular diseases. The “unadjusted” posterior ORs of Barthel improvement were controlled for squared Barthel score on admission.
Abbreviations: CrI, credible interval.
Table 4
Results from Bayesian multilevel logistic regression analysis: association of skill mix and care processes of community hospitals with the study outcomes, Emilia-Romagna, year 2017. Odds ratio (OR) estimates are adjusted for patient-level characteristics listed in Table 3.
| PREDICTOR | BARTHEL SCORING IMPROVEMENT ≥10 | TRANSFER TO ACUTE CARE HOSPITAL | LENGTH OF STAY ≥20 DAYS | |||
|---|---|---|---|---|---|---|
| POSTERIOR OR | 95% CRED. INTERVAL | POSTERIOR OR | 95% CRED. INTERVAL | POSTERIOR OR | 95% CRED. INTERVAL | |
| Medical support (specialist vs GP) | 1.66 | 0.28–6.71 | 0.79 | 0.45–1.31 | 0.51 | 0.15–1.22 |
| Years of operation (≥2 vs <2) | 1.16 | 0.23–3.91 | 0.95 | 0.55–1.51 | 1.24 | 0.46–2.85 |
| Nurses’ working hours/week/bed (>12 vs ≤12) | 0.94 | 0.14–3.72 | 1.20 | 0.70–2.00 | 1.39 | 0.47–3.26 |
| Patients/year (≥150 vs <150) | 3.78 | 0.59–13.6 | 0.61 | 0.33–1.07 | 1.02 | 0.31–2.54 |
| Variance Partition Coefficient (VPC) | 0.285 | 0.055 | 0.143 | |||