THE NEED FOR ACUTE, SUBACUTE AND NONACUTE CARE AT 105 GENERAL-HOSPITAL SITES IN ONTARIO

Background: Previous studies of hospital utilization have not taken in to account the use of acute care beds for subacute care. The authors d etermined the proportion of patients who required acute, subacute and nonacute care on admission and during their hospital stay in general h ospitals in Ontario. From this analysis, they identified areas where t he efficiency of care delivery might be improved. Methods: Ninety-eigh t of 189 acute care hospitals in Ontario, at 105 sites, participated i n a review that used explicit criteria for rating acuity developed by Inter-Qual Inc., Marlborough, Mass. The records of 13 242 patients who were discharged over a 9-month period in 1995 after hospital care for 1 of 8 high-volume, high-variability diagnoses or procedures were ran domly selected for review. Patients were categorized on the basis of t he revel of care (acute, subacute or nonacute) they required on admiss ion and during subsequent days of hospital care. Results: Of all admis sions, 62.2% were acute, 19.7% subacute and 18.1% non-acute: The patie nts most likely to require acute care on admission were those with acu te myocardial infarction (96.2% of 1826 patients) or cerebrovascular a ccident (84.0% of 1596 patients) and those admitted for elective surge ry on the day of their procedure (73.4% of 3993 patients). However, 41 .1% of patients awaiting hip or knee replacement were admitted the day before surgery so did not require acute care on admission. The propor tion of patients who required acute care on admission and during the s ubsequent hospital stay declined with age; the proportion of patients needing nonacute care did not vary with age. After admission, acute ca re was needed on 27.5% of subsequent days, subacute care on 40.2% and nonacute care on 32.3%. The need for acute care on admission was a pre dictor of need for acute care during subsequent hospital stay among pa tients with medical conditions. The proportion of patients requiring s ubacute care during the subsequent hospital stay increased with age, d ecreased with the number of inpatient beds in each hospital and was hi ghest among patients with congestive heart failure, chronic obstructiv e pulmonary disease and pneumonia. Interpretation: In 1995, inpatients requiring subacute care accounted for a substantial proportion of non acute care days in Ontario's general hospitals. These findings suggest a need to evaluate the efficiencies that might be achieved by introdu cing a subacute category of care into the Canadian health care system. Generally, efforts are needed to reduce the proportion of admissions for nonacute care and of in-hospital days for other than acute care.