Intermediate care: for better or worse? Process evaluation of an intermediate care model between a university hospital and a residential home

A process evaluation was carried out using quantitative and qualitative methods. Registration forms and patient questionnaires were used to quantify the patient population in the model. Statistical analysis encompassed T-tests and chi-squared test to assess significance. Semi-structured interviews were conducted with 21 staff members representing all disciplines working with the model. Interviews were transcribed and analysed using both 'open' and 'framework' approaches.Despite high expectations, there were significant problems. A heterogeneous patient population, a relatively unqualified staff and cultural differences between both collaborating partners impeded implementation and had an impact on the functioning of the model.We concluded that setting up a low intensity early discharge model of intermediate care between a university hospital and a residential home is less straightforward than was originally perceived by management, and that quality of care needs careful monitoring to ensure the change is for the better.Due to technological developments, better communication facilities and further differentiation and specialisation of professionals, patient care is increasingly provided outside hospitals. Financiers, governments and patients advocate this development, as they consider outpatient care to be more efficient and patient centred [1].This shift has repercussions for chronically ill and elderly patients with complex care needs. First, it is questionable whether optimal care for these patients can be delivered in an outpatient setting. They need sufficient time to recover and are often in frail health [2]. Early hospital discharge can present dangers for them. Moreover, alternatives are often scarce, as the capacity of long-term care facilities is either limited or too expensive. What is known as 'bed-blocking' occurs when patients whose medical treatment has been completed cannot be discharged because of poor continuation of care outside the hospital [3].Se