The implementation and evaluation of an acute geriatric community hospital in the Netherlands

The aim of this thesis was to provide evidence concerning the implementation and effectiveness of the Acute Geriatric Community Hospital (AGCH, WijkKliniek in Dutch) that was newly opened in the Netherlands. The AGCH is an acute geriatric unit located in a skilled nursing facility. Hospitalization in older adults is associated with unwanted outcomes such as functional decline, delirium, unplanned readmissions, and institutionalization. Admission to the AGCH is an alternative to conventional hospitalization. Admission to the AGCH may help prevent negative outcomes of hospitalization in older adults. In this thesis we present the study protocol and results of the AGCH prospective cohort study which is controlled with a historical control group. This study showed a difference in the primary outcome, the rate of 90-day readmission or death. Secondary outcomes showed mixed results. Functional dependence over time, falls, institutionalization, were not different compared to the control group. Patient satisfaction was high and incidence rates of delirium were lower compared to control groups from literature. In our qualitative process evaluation, we found that involved healthcare providers, care organizations and the health insurer were supportive of the AGCH concept. The results from this thesis support implementation elsewhere and can assist in future work on the development, implementation, and evaluation of the AGCH at other locations.