ABSTRACT
Introduction: Little data is available on community hospital admissions. We examined the differences between community hospitals and the annual trends in sociodemographic characteristics of all patient admissions in Singaporean community hospitals over a 10- year period from 1996 to 2005.
Materials and Methods: Data were manually extracted from medical records of 4 community hospitals existent in Singapore from 1996 to 2005. Nineteen thousand and three hundred and sixty patient records were examined. Chi-square test was used for univariate analysis of categorical variables by type of community hospitals. For annual trends, test for linear by linear association was used. ANOVA was used to generate beta coefficients for continuous variables. Results: Mean age of all patient admissions has increased from 72.8 years in 1996 to 74.8 years in 2005. The majority was Chinese (88.4%), and female (58.1%) and admissions were mainly for rehabilitation (88.0%). Almost one third had foreign domestic workers as primary caregivers and most (73.5%) were discharged to their own home. There were significant differences in socio-demographic profile of admissions between hospitals with one hospital having more patients with poor social support. Over the 10-year period, the geometric mean length of stay decreased from 29.7 days (95% CI, 6.4 to 138.0) to 26.7 days (95% CI, 7.5 to 94.2), and both mean admission and discharge Barthel Index scores increased from 41.0 (SD = 24.9) and 51.8 (SD = 30.0), respectively in 1996 to 48.4 (SD = 24.5) and 64.2 (SD = 27.3) respectively in 2005. Conclusion: There are significant differences in socio-demographic characteristics and clinical profile of admissions between various community hospitals and across time. Understanding these differences and trends in admission profiles may help in projecting future healthcare service needs.Intermediate care, a range of services facilitating step-down care from the hospital to home, has become an integral part of the healthcare system. Community hospitals, defined as smaller hospitals with fewer onsite facilities or specialist services which are more suited for acute specialised care, are key providers of intermediate care. Patients are admitted to community hospitals for various purposes, such as rehabilitation, subacute care, palliative care and respite care. These community hospitals can be viable alternatives to acute hospitals by increasing functional independence post-rehabilitation and reducing long-term mortality as well as readmissions to acute care while remaining as cost-effective as elderly care departments in acute hospitals. While a wealth of literature exists on the benefits of community hospitals for various disease-specific outcomes, there has been little evaluation of changes over time with regard to patient characteristics, medical comorbidities, and functional status of patients admitted to community hospitals. The lack of routine data on community hospital activities poses problems when evaluating their role in healthcare delivery. The few existing studies, mainly from United Kingdom (UK), demonstrate that there can be significant changes in casemix, patient profile, and purpose of admission both over time and between community hospitals in the same region. Particularly in Asia, where ageing populations will likely increase demand for intermediate care, such studies would help in planning healthcare service delivery in these societies.
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