{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,15]],"date-time":"2026-07-15T18:09:53Z","timestamp":1784138993071,"version":"3.55.0"},"reference-count":30,"publisher":"Public Library of Science (PLoS)","issue":"7","license":[{"start":{"date-parts":[[2026,7,15]],"date-time":"2026-07-15T00:00:00Z","timestamp":1784073600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100001826","name":"ZonMW","doi-asserted-by":"publisher","award":["10020032210003"],"award-info":[{"award-number":["10020032210003"]}],"id":[{"id":"10.13039\/501100001826","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["www.plosone.org"],"crossmark-restriction":false},"short-container-title":["PLoS One"],"abstract":"<jats:sec id=\"sec001\">\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>Short-term residential care (STRC) is a Dutch form of post-acute care intended to return older adults home to live independently, yet fewer than 55% of patients are discharged home. Because post-acute care costs are unevenly distributed, average cost trajectories may obscure clinically meaningful variation. This study examines variation in STRC cost trajectories and identifies patient characteristics associated with high-cost group membership.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"sec002\">\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We conducted a retrospective longitudinal observational study using national health claims data from Statistics Netherlands for patients admitted to STRC between 1 February and 31 July 2022. Reimbursed costs across seven categories (STRC, inpatient and outpatient hospital care, district care, long-term care at home, nursing home admission, and geriatric rehabilitation) were measured from one month before to five months after admission. We defined a palliative care group a priori and applied group-based trajectory modelling to the remaining cohort. Two logistic regressions assessed patient-level predictors of high-cost membership.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"sec003\">\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Among 16,278 patients, mean six-month costs were \u20ac29,859 (SD\u2009=\u2009\u20ac21,088). We identified an a priori palliative care group (n\u2009=\u20093,277; \u20ac23,200), a latent high-cost (n\u2009=\u20093,205; \u20ac58,478) and a latent low-cost (n\u2009=\u20099,796; \u20ac22,723) group. The high-cost group accounted for 39% of total costs, with the largest shares attributable to hospital care, nursing home admission, and longer STRC stays. These patients were more often readmitted to hospital within two weeks of discharge (16.9% versus 3.2%) and discharged to a nursing home (29.8% versus 10.7%). Dementia, institutional living, and several diagnosis groups (including stroke, oncology, organ failure, and cardiovascular disease) were associated with high-cost membership, but overall explanatory power was low (McFadden pseudo R\u00b2\u2009\u2264\u20090.05).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"sec004\">\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>STRC cost trajectories were highly skewed and poorly predicted by routinely available patient characteristics, suggesting cost variation reflects differences in care delivery more than patient case-mix. These findings point to three priorities: strengthening transitions from STRC back to home, critically evaluating STRC placement for patients likely to require nursing home admission, and scrutinizing hospital use during STRC episodes. Cost trajectories offer a promising outcome measure for evaluating intermediate and integrated care.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1371\/journal.pone.0351837","type":"journal-article","created":{"date-parts":[[2026,7,15]],"date-time":"2026-07-15T17:33:01Z","timestamp":1784136781000},"page":"e0351837","update-policy":"https:\/\/doi.org\/10.1371\/journal.pone.corrections_policy","source":"Crossref","is-referenced-by-count":0,"title":["Exploring cost trajectories of patients admitted to short-term residential care in the Netherlands"],"prefix":"10.1371","volume":"21","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-4730-3178","authenticated-orcid":true,"given":"Eline D.","family":"Kroeze","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Janet L.","family":"MacNeil Vroomen","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Astrid","family":"Preitschopf","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anneke J. A. H.","family":"van Vught","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bianca M.","family":"Buurman","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"340","published-online":{"date-parts":[[2026,7,15]]},"reference":[{"key":"pone.0351837.ref001","doi-asserted-by":"crossref","first-page":"162","DOI":"10.1016\/j.healthpol.2007.03.008","article-title":"Empowering the chronically ill? Patient collectives in the new Dutch health insurance system","volume":"84","author":"Y Bartholom\u00e9e","year":"2007","journal-title":"Health Policy"},{"issue":"3","key":"pone.0351837.ref002","doi-asserted-by":"crossref","first-page":"241","DOI":"10.1016\/j.healthpol.2016.01.014","article-title":"The policy and politics of the 2015 long-term care reform in the Netherlands","volume":"120","author":"JAMH Maarse","year":"2016","journal-title":"Health Policy"},{"issue":"6","key":"pone.0351837.ref003","doi-asserted-by":"crossref","DOI":"10.1016\/S2666-7568(23)00064-8","article-title":"Acute hospital use in older adults following the 2015 Dutch reform of long-term care: an interrupted time series analysis","volume":"4","author":"JD Wammes","year":"2023","journal-title":"Lancet Healthy Longev"},{"key":"pone.0351837.ref004","author":"JH Van den Besselaar"},{"issue":"7","key":"pone.0351837.ref005","doi-asserted-by":"crossref","first-page":"945","DOI":"10.1016\/j.jamda.2023.04.026","article-title":"Avoiding hospital admissions and delayed transfers of care by improved access to intermediate care: a simulation study","volume":"24","author":"RJ Arntzen","year":"2023","journal-title":"J Am Med Dir Assoc"},{"key":"pone.0351837.ref006","author":"JH van den Besselaar"},{"key":"pone.0351837.ref007","volume-title":"Infographic short-term residential stay (In Dutch: Infographic ELV)","author":"Actiz","year":"2025"},{"issue":"11","key":"pone.0351837.ref008","article-title":"Characteristics and healthcare utilisation patterns of high-cost beneficiaries in the Netherlands: a cross-sectional claims database study","volume":"7","author":"JJG Wammes","year":"2017","journal-title":"BMJ Open"},{"issue":"10","key":"pone.0351837.ref009","doi-asserted-by":"crossref","DOI":"10.1016\/j.jamda.2019.03.013","article-title":"Determinants of post-acute care costs in acutely hospitalized older adults: the hospital-ADL study","volume":"20","author":"ME Ribbink","year":"2019","journal-title":"J Am Med Dir Assoc"},{"key":"pone.0351837.ref010","author":"Ministry of Health, Welfare and Sport","year":"2016"},{"issue":"6","key":"pone.0351837.ref011","doi-asserted-by":"crossref","first-page":"961","DOI":"10.1007\/s41999-020-00365-4","article-title":"The effectiveness of intermediate care including transitional care interventions on function, healthcare utilisation and costs: a scoping review","volume":"11","author":"D Sezgin","year":"2020","journal-title":"Eur Geriatr Med"},{"issue":"1","key":"pone.0351837.ref012","doi-asserted-by":"crossref","first-page":"107","DOI":"10.1016\/j.ijnurstu.2004.07.010","article-title":"Post-acute intermediate care in nursing-led units: a systematic review of effectiveness","volume":"42","author":"P Griffiths","year":"2005","journal-title":"Int J Nurs Stud"},{"key":"pone.0351837.ref013","doi-asserted-by":"crossref","first-page":"109","DOI":"10.1146\/annurev.clinpsy.121208.131413","article-title":"Group-based trajectory modeling in clinical research","volume":"6","author":"DS Nagin","year":"2010","journal-title":"Annu Rev Clin Psychol"},{"issue":"9596","key":"pone.0351837.ref014","doi-asserted-by":"crossref","first-page":"1453","DOI":"10.1016\/S0140-6736(07)61602-X","article-title":"The Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) statement: guidelines for reporting observational studies","volume":"370","author":"E von Elm","year":"2007","journal-title":"Lancet"},{"issue":"10","key":"pone.0351837.ref015","doi-asserted-by":"crossref","DOI":"10.1371\/journal.pmed.1001885","article-title":"The REporting of studies Conducted using Observational Routinely-collected health Data (RECORD) statement","volume":"12","author":"EI Benchimol","year":"2015","journal-title":"PLoS Med"},{"key":"pone.0351837.ref016","author":"Statistics Netherlands (CBS)"},{"key":"pone.0351837.ref017","doi-asserted-by":"crossref","DOI":"10.4159\/9780674041318","volume-title":"Group-based modeling of development","author":"DS Nagin","year":"2005"},{"issue":"1","key":"pone.0351837.ref018","doi-asserted-by":"crossref","first-page":"92","DOI":"10.1006\/jmps.1999.1278","article-title":"Bayesian model selection and model averaging","volume":"44","author":"L Wasserman","year":"2000","journal-title":"J Math Psychol"},{"issue":"2","key":"pone.0351837.ref019","doi-asserted-by":"crossref","first-page":"553","DOI":"10.1093\/bib\/bbz016","article-title":"Sensitivity and specificity of information criteria","volume":"21","author":"JJ Dziak","year":"2020","journal-title":"Brief Bioinform"},{"key":"pone.0351837.ref020","doi-asserted-by":"crossref","first-page":"128","DOI":"10.1186\/s12913-016-1360-3","article-title":"Associations of frailty with health care costs--results of the ESTHER cohort study","volume":"16","author":"J-O Bock","year":"2016","journal-title":"BMC Health Serv Res"},{"issue":"3","key":"pone.0351837.ref021","doi-asserted-by":"crossref","first-page":"255","DOI":"10.1093\/gerona\/59.3.M255","article-title":"Untangling the concepts of disability, frailty, and comorbidity: implications for improved targeting and care","volume":"59","author":"LP Fried","year":"2004","journal-title":"J Gerontol A Biol Sci Med Sci"},{"issue":"3","key":"pone.0351837.ref022","doi-asserted-by":"crossref","first-page":"365","DOI":"10.1016\/S0167-6296(98)00056-3","article-title":"On the use of survival analysis techniques to estimate medical care costs","volume":"18","author":"RD Etzioni","year":"1999","journal-title":"J Health Econ"},{"key":"pone.0351837.ref023","doi-asserted-by":"crossref","first-page":"21","DOI":"10.7705\/biomedica.5987","article-title":"Pitfalls and perils of survival analysis under incorrect assumptions: the case of COVID-19 data","volume":"41","author":"D Piovani","year":"2021","journal-title":"Biomedica"},{"issue":"5","key":"pone.0351837.ref024","doi-asserted-by":"crossref","first-page":"823","DOI":"10.1586\/14737167.2015.1091730","article-title":"Multiple chronic conditions and healthcare costs among adults","volume":"15","author":"U Sambamoorthi","year":"2015","journal-title":"Expert Rev Pharmacoecon Outcomes Res"},{"issue":"3","key":"pone.0351837.ref025","doi-asserted-by":"crossref","first-page":"1168","DOI":"10.1111\/1475-6773.12518","article-title":"The dynamics of hospital use among older people evidence for europe using SHARE data","volume":"52","author":"N Sirven","year":"2017","journal-title":"Health Serv Res"},{"issue":"4","key":"pone.0351837.ref026","doi-asserted-by":"crossref","first-page":"408","DOI":"10.5034\/inquiryjrnl_45.04.408","article-title":"Costly hospital readmissions and complex chronic illness","volume":"45","author":"B Friedman","year":"2008","journal-title":"Inquiry"},{"key":"pone.0351837.ref027","doi-asserted-by":"crossref","first-page":"102823","DOI":"10.1016\/j.jhealeco.2023.102823","article-title":"The health effects of nursing home specialization in post-acute care","volume":"92","author":"ZS Templeton","year":"2023","journal-title":"J Health Econ"},{"issue":"5","key":"pone.0351837.ref028","doi-asserted-by":"crossref","DOI":"10.1002\/gps.6094","article-title":"Costs of care trajectories of people with dementia compared with matched controls. Longitudinal analysis of linked health and administrative data","volume":"39","author":"JE Bosmans","year":"2024","journal-title":"Int J Geriatr Psychiatry"},{"issue":"2","key":"pone.0351837.ref029","doi-asserted-by":"crossref","first-page":"111","DOI":"10.1002\/gps.4198","article-title":"The main cost drivers in dementia: a systematic review","volume":"30","author":"S Schaller","year":"2015","journal-title":"Int J Geriatr Psychiatry"},{"issue":"12","key":"pone.0351837.ref030","doi-asserted-by":"crossref","first-page":"2411","DOI":"10.2105\/AJPH.2015.302889","article-title":"The myth regarding the high cost of end-of-life care","volume":"105","author":"MD Aldridge","year":"2015","journal-title":"Am J Public Health"}],"container-title":["PLOS One"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pone.0351837","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,7,15]],"date-time":"2026-07-15T17:33:06Z","timestamp":1784136786000},"score":1,"resource":{"primary":{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pone.0351837"}},"subtitle":[],"editor":[{"given":"Robert Jeenchen","family":"Chen","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"editor"}]}],"short-title":[],"issued":{"date-parts":[[2026,7,15]]},"references-count":30,"journal-issue":{"issue":"7","published-online":{"date-parts":[[2026,7,15]]}},"URL":"https:\/\/doi.org\/10.1371\/journal.pone.0351837","relation":{},"ISSN":["1932-6203"],"issn-type":[{"value":"1932-6203","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,7,15]]}}}