Community hospitals in high-income countries: a review of the evidence on effectiveness and efficiency

Problem

Community hospitals are an attractive option for governments seeking to integrate primary and other care services locally, but evidence of their added value is relatively sparse. This review seeks to assess the evidence on the effectiveness and efficiency of community hospitals in selected high-income countries.

Approach

We undertook a systematic review of studies on the effectiveness and efficiency of community hospitals published from 2005 to 2014. Included studies compared care at community hospitals with care provided in other hospital settings. Data were extracted on a range of measures of effectiveness and efficiency. Studies were assessed for risk of bias. Data were analysed using a narrative synthesis approach, to report on patient health outcomes, patient and carer experience and satisfaction, organisational outcomes and cost-effectiveness.

Findings

Eight studies (in 17 papers) from two countries reported improved or equivalent patient health outcomes at community hospitals compared with acute hospitals for post-acute care. Patient/carer experiences were better at community hospitals than acute hospitals for palliative care, post-acute care and chemotherapy. One study reported improvements in the discharge process from acute to primary care. Cost-effectiveness results were mixed. Cost of post-acute care was similar or lower in community hospitals than acute hospitals. Drug and intervention costs for emergency care were reported to be lower at one community hospital compared to the acute hospital, resulting in lower overall costs. However, the cost of delivering chemotherapy in community hospitals was marginally higher than in a cancer centre.

Consequences

Community hospitals offered an effective alternative to acute hospitals for the delivery of a range of healthcare services, but evidence on cost-effectiveness was mixed. Evidence of community hospital effectiveness and efficiency remains limited in geographical scope and primarily focused on post-acute care. As the policy vision for community hospitals continues to develop, further research is needed to underpin the design of future care models.