A case vignette study to refine the target group of an intermediate care model: the Acute Geriatric Community Hospital

Refining the admission criteria of the Acute Geriatric Community Hospital (AGCH) by defining its target group boundaries with (geriatric) hospital care and other bed-based intermediate care models. The integration of medical specialist care (MSC) and medical generalist care (MGC) is unique for the AGCH compared to other intermediate care models and (geriatric) hospital care in the Netherlands. Based on these findings, 13 refined admission criteria were developed. Also, 10 additional consideration themes were identified. Because care is shifting from hospitals to the community, target group boundaries between (intermediate) care models should be continuously (re)defined; based on our experiences, we recommend using case vignettes as this yields rich and practical input. To refine the admission criteria of the Acute Geriatric Community Hospital (AGCH) by defining its target group boundaries with (geriatric) hospital care and other bed-based intermediate care models in the Netherlands. A qualitative study consisting of a three-phase refinement procedure with case vignettes. Physicians, medical specialists, nurse practitioners, and physician assistants in hospitals (n = 10) or intermediate care facilities (n = 10) in the Netherlands participated. They collected case vignettes from clinical practice (phase one). The referral considerations and decisions for each case were then documented through surveys (phase two) and two focus groups (phase 3). For thematic data analysis, inductive and deductive approaches were used. The combination of medical specialist care (MSC) and medical generalist care (MGC), is unique for the AGCH compared to other intermediate care models in the Netherlands. Compared to (geriatric) hospital care, the AGCH offers a more limited scope of MSC. Based on these findings, 13 refined admission criteria were developed such as ‘The required diagnostic tests to monitor the effectiveness of treatment are available at the AGCH’. Besides admission criteria, additional clinical and organizational considerations played a role in referral decision-making; 10 themes were identified. This case vignette study defined the target group boundaries between the AGCH and other care models, allowing us to refine the AGCH admission criteria. Our findings may help to determine the required competencies of the interdisciplinary AGCH team and to develop triage instruments. The identified consideration themes can be used as conceptual framework in further research. The findings may also be of interests for healthcare systems outside the Netherlands who aspire to design integrated care for older people closer to home.