Background
Methods
Study design
Description of AGR intervention and eligibility criteria
In- and exclusion criteria from the analyses
Exclusion criteria | Number of excluded AGR participants (n = 28)b |
---|---|
○ < 360 insured days in the four previous billing periods | 0 |
○ nursing care level > 2 | 0 |
○ living in a nursing home | 0 |
○ HIV/AIDS | 0 |
○ chemotherapy | 20 |
○ organ transplantation | 0 |
○ dialysis | 0 |
○ death including index perioda | 0 |
○ hospital costs without out of pocket spending at the last previous billing period ≥33.000 € | 1 |
○ hospital costs without out of pocket spending during the four previous billing periods ≥44.000 € | 3 |
○ ambulatory costs during the last previous billing period ≥2.200 € | 3 |
○ ambulatory costs in the four previous billing periods ≥5.500 € | 1 |
○ remedy costs without out of pocket spending during the four previous billing periods ≥2.200 € | 1 |
○ costs of aid without out of pocket spending during the four previous billing periods ≥4.000€ | 1 |
○ drug costs without out of pocket spending during the four previous billing periods ≥11.000 € | 2 |
○ total health care costs without of pocket spending during the four previous billing periods ≥44.000 € | 3 |
Matching of controls
Matching criterion | Pre matching | Propensity score | Main matching |
---|---|---|---|
Age | x | x | x |
Sex | x | x | |
Area of residence | x | ||
Level of nursing care | x | x | x |
Hospital admission (Yes/No) | x | x | x |
Days spent in hospital | x | ||
Hospital costs without out of pocket spending | x | x | x |
Ambulatory costs | x | x | |
Costs of remedy | x | x | |
Costs of medical aid | x | x | |
Drug costs without out of pocket spending | x | x | x |
Total costs without out of pocket spending | x | ||
Main diagnosis before AGR | |||
Cox- or gonarthrosis with endoprothesis | x | x | x |
status post fracture and injuries | x | x | x |
Other arthropaties | x | x | x |
Osteoporosis | x | x | x |
Spondylopathies and Discopathies, possibly with laminectomy | x | x | x |
Pneumonia and other lung inflammations | x | x | x |
Chronic obstructive pulmonary disease (COPD) | x | ||
Arterial obstructive disease with amputation or other surgery | x | x | |
Stroke and other cerebrovascular diseases | x | x | |
Coronary heart diseases with surgery | x | x | |
Delirium or other organic brain psychosis (1) only with a second main diagnosis; 2) does not apply if this diagnosis is an exclusion criterion) | x | x | x |
Secondary Parkinson syndrome | x | x | x |
Symptoms, effecting the nervous system and musculoskeletal system | x | x | x |
Charlson Comorbidity Index | x | ||
Any Malignancy | x | x | x |
Cerebrovascular disease | x | ||
Chronic pulmonary disease | x | ||
Congestive heart failure | x | ||
Metastatic solid tumour | x | x | |
Dementia | x | x | |
Hemiplegia or paraplegia | x | ||
Mild liver disease | x | ||
Myocardial infarction | x | ||
Renal disease | x | ||
Peripheral vascular disease | x | ||
Geriatric Multimorbidity | |||
Immobility | x | x | x |
Cognitive deficit | x | ||
Chronic pain | x | ||
Depression, Anxiety | x | ||
Incontinence | x | ||
Paraesthesia | x | ||
severe visual/hearing impairment | x | ||
Falls and fractures | |||
Injuries of the head | x | ||
Injuries of the neck | x | ||
Injuries of the thorax | x | ||
Injuries of the abdomen, the lumbosacral region, the lumbar spine and the pelvis | x | ||
Injuries of the shoulder and the upper arm | x | ||
Injuries of the elbow and the under arm | x | ||
Injuries of the wrist and the hand | x | ||
Injuries of the hip and the thigh | x | ||
Injuries of multiple body regions | x | ||
Injuries of unspecific parts of the torso, extremity or other body regions | x x |
The matching was performed in several steps
Outcomes and statistical analyses
Nursing care level | Requirements | |
---|---|---|
Total daily help (including help in household) | Personal help (included in total daily help) | |
1 | minimum 1,5 h | > 45 min |
2 | minimum 3 h | ≥2 h, 3 times a day |
3 | minimum 5 h | ≥4 h permanent help |
Results
N = 632 | % AGR | % Controls | % Difference | 95% CI | p-value |
---|---|---|---|---|---|
progression of nursing care level | 15.1 | 12.9 | 2.2 | −0.9 – 5.3 | 0.17 |
nursing home admission | 4.8 | 3.1 | 1.7 | −0.1 – 3.5 | 0.06 |
hospital admission | 39.6 | 38.5 | 1.1 | −3.2 – 5.4 | 0.61 |
incident fractures | 29.1 | 18.0 | 11.1 | 7.3–15 | < 0.001 |
mortality | 4.9 | 3.7 | 1.2 | -a | 0.20 |
total costs | 227 € | 580 € | −353 € | −989 € - 282 € | 0.28 |
total costs without outlier | − 442 € | − 297 € | −144 € | −659 € - 371 € | 0.58 |