Abstract
Background In 2015, the Dutch government implemented a long-term care (LTC) reform primarily designed to
promote older adults to age-in-place. Increased proportions of older adults living in the community might have
resulted in more and longer acute hospitalisations. The aims of this study were to evaluate whether the Dutch 2015
LTC reform was associated with immediate and longitudinal increases in the monthly rate of acute clinical
hospitalisation and monthly average hospital length of stay (LOS) in adults aged 65 years or older.
Methods In this interrupted time series analysis of national hospital data (2009–18), we evaluated the association of
the Dutch 2015 LTC reform with the monthly rate of acute clinical hospitalisation and monthly average LOS for older
adults (aged ≥65 years). Patient-level episodic hospital data were provided by Dutch Hospital Data. Records were
included that were defined as an acute clinical hospital admission for which a medical specialist decided treatment
was necessary within 24 h. The analysis controlled for population growth (Dutch population data was provided by
Statistics Netherlands) and seasonality, and calculated adjusted incident rate ratios (IRR).
Findings Before the 2015 LTC reform, the rate of acute monthly hospitalisation was increasing (IRR 1·002 [95% CI
1·001–1·002]). A positive average reform effect was observed (1·116 [1·070–1·165]), accompanied by a negative change
in trend (0·997 [0·996–0·998]) that resulted in a decreasing trend over the post-reform period (0·998 [0·998–0·999]).
The pre-reform trend of LOS was decreasing (0·998 [0·997–0·998]), and the 2015 reform exhibited a positive change
in trend (1·002 [1·002–1·003]) that resulted in a stabilisation of LOS in the post-reform period (0·999 [0·999–1·000]).
Interpretation Our findings suggest that the increase in the rate of acute hospitalisation after the reform
implementation was temporary, whereas the increase in LOS post-reform appeared to last longer than expected.
These results have the potential to inform policy makers about effects of ageing-in-place LTC strategies on health and
curative care.
promote older adults to age-in-place. Increased proportions of older adults living in the community might have
resulted in more and longer acute hospitalisations. The aims of this study were to evaluate whether the Dutch 2015
LTC reform was associated with immediate and longitudinal increases in the monthly rate of acute clinical
hospitalisation and monthly average hospital length of stay (LOS) in adults aged 65 years or older.
Methods In this interrupted time series analysis of national hospital data (2009–18), we evaluated the association of
the Dutch 2015 LTC reform with the monthly rate of acute clinical hospitalisation and monthly average LOS for older
adults (aged ≥65 years). Patient-level episodic hospital data were provided by Dutch Hospital Data. Records were
included that were defined as an acute clinical hospital admission for which a medical specialist decided treatment
was necessary within 24 h. The analysis controlled for population growth (Dutch population data was provided by
Statistics Netherlands) and seasonality, and calculated adjusted incident rate ratios (IRR).
Findings Before the 2015 LTC reform, the rate of acute monthly hospitalisation was increasing (IRR 1·002 [95% CI
1·001–1·002]). A positive average reform effect was observed (1·116 [1·070–1·165]), accompanied by a negative change
in trend (0·997 [0·996–0·998]) that resulted in a decreasing trend over the post-reform period (0·998 [0·998–0·999]).
The pre-reform trend of LOS was decreasing (0·998 [0·997–0·998]), and the 2015 reform exhibited a positive change
in trend (1·002 [1·002–1·003]) that resulted in a stabilisation of LOS in the post-reform period (0·999 [0·999–1·000]).
Interpretation Our findings suggest that the increase in the rate of acute hospitalisation after the reform
implementation was temporary, whereas the increase in LOS post-reform appeared to last longer than expected.
These results have the potential to inform policy makers about effects of ageing-in-place LTC strategies on health and
curative care.
| Original language | English |
|---|---|
| Pages (from-to) | E257-E264 |
| Journal | The Lancet Healthy Longevity |
| Volume | 4 |
| Issue number | 6 |
| DOIs | |
| Publication status | Published - Jun 2023 |
Bibliographical note
Funding:The Netherlands Organization for Health Research and Development, the Yale Claude Pepper Center, and the National Center for Advancing Translational Sciences, National Institutes of Health.
