Department of Geriatric Medicine, Tan Tock Seng Hospital, Singapore.
Ann Acad Med Singap. 2012 Aug;41(8):354-61.
The subacute care unit in Tan Tock Seng Hospital (TTSH) was set up in May 2009. We examined its impact on the transitions at the nexus between hospital and community sectors, patients' discharge destination and functional performance.
We studied patients admitted during the initial 6-month period (May to October 2009). Differences in demographics, length of stay (LOS), comorbidity and severity of illness measures, functional outcomes (modified Barthel Index (MBI)) according to discharge destinations were obtained. We also studied the impact of LOS on the geriatric department and the bill size over the pre- and post-subacute implementation periods.
Majority of the subacute patients' hospital stay was in subacute care. Of these patients, 44.9% were discharged home, 24.2% to a slow stream rehabilitation (SSR) setting and 29.2% to nursing homes. 16.9% consisted of a subgroup of dementia patients requiring further behavioural and functional interventions, of which 50% managed to be discharged home. Functional gains were seen during subacute stay; with greatest gains observed in the SSR group. There were no differences in overall LOS nor total bill size (DRG-adjusted) for the geriatric medicine department during the first 6 months of operating this new subacute model compared with the prior 4-month period.
We propose this subacute model of geriatric care, which allows right-siting of care and improved functional outcomes. It fulfills the role easing transitions between acute hospital and community sectors. In particular, it provides specialised care to a subgroup of dementia patients with challenging behaviours and is fiscally sound from the wider hospital perspective.
陈笃生医院（TTSH）的亚急性护理病房于 2009 年 5 月成立。我们研究了它对医院和社区部门之间交接处的过渡、患者出院去向和功能表现的影响。
我们研究了在最初 6 个月期间（2009 年 5 月至 10 月）入院的患者。根据出院去向，比较了人口统计学、住院时间（LOS）、合并症和疾病严重程度测量、功能结果（改良巴氏指数（MBI））的差异。我们还研究了 LOS 对老年科和预实施和实施亚急性病房前后账单大小的影响。
大多数亚急性患者的住院时间都在亚急性护理病房。这些患者中，44.9%出院回家，24.2%到缓慢流动康复（SSR）机构，29.2%到疗养院。16.9%由需要进一步行为和功能干预的痴呆症患者组成，其中 50%的患者能够出院回家。在亚急性住院期间观察到功能改善；SSR 组的改善最大。与前 4 个月相比，在运行这种新的亚急性模式的头 6 个月内，老年医学科的总 LOS 和总账单大小（DRG 调整）没有差异。
我们提出了这种老年护理亚急性模式，它允许正确定位护理并改善功能结果。它满足了缓解急性医院和社区部门之间过渡的角色。特别是，它为有挑战性行为的痴呆症患者亚组提供了专门的护理，从更广泛的医院角度来看是合理的。
