Two Dutch Examples of Acute Geriatric Community Hospitals for Older Adults: A Comparative Process Evaluation

Background: Older adults with frailty are at high risk of adverse outcomes during hospitalisation. To address this, two Acute Geriatric Community Hospitals (AGCH1 and AGCH2) were established in the Netherlands. This study examined similarities and differences in setting, staffing, care pathways, patient populations, outcomes, and improvement opportunities in the first quarter of 2024.

Methods: We conducted a mixed-methods evaluation using questionnaires (n = 2), documents (n = 10), case vignettes (n = 20), case vignette surveys (n = 7), and focus groups (n = 2). Quantitative data on patients admitted between January 1 and March 31, 2024, (n = 161) were collected in aggregated form via the questionnaires and analysed descriptively; qualitative data were analysed thematically.

Results: Both sites implemented the core model elements but varied in setting and staffing. Patients showed high multimorbidity with respiratory conditions and infections as common diagnoses. Across ten case vignettes per AGCH, experts reported variation in referral appropriateness. Mean length of stay was shorter at AGCH2 (9.0 vs. 12.5 days), while less patients were discharged home (51.7% vs. 70.3%). Focus groups highlighted seven improvement areas: referral, expectation management, discharge planning, IT integration, funding, and evening/night/weekend care.

Conclusions: The two AGCHs appeared to have largely similar care pathways, patient populations, and improvement opportunities, but differed in context, staffing, and outcomes. Sustainable implementation requires continuous learning, clear referral pathways, and skill mix review; national scale-up demands effectiveness studies, role delineation, and defining core versus adaptable model elements.