Community hospitals and older people.

Recent health care policy has promoted the community hospital as one remedy for the contracted district general hospital. Unfortunately, a literature review reveals a weak evidence-base to support this policy. Although descriptive studies demonstrate the flexible, multi-purpose role of community hospitals, there is a worrying paucity of clinical outcome studies and no robust health economic evaluation. An important potential role for community hospitals is in the post-acute care of older people. However, evaluation by randomized trial is required to demonstrate effectiveness and cost effectiveness of community hospital transfer compared to alternatives such as remaining in a district general hospital.