OBJECTIVE: To explore whether a home-based intermediate care program in a large Canadian city lowers the cost of care and to look at whether such home-based programs could be a solution to the increasing demands on Canadian hospitals. DESIGN: Single-arm study with historical controls. SETTING: Department of Family Medicine at the Ottawa Hospital (Civic campus) in Ontario. PARTICIPANTS: Patients requiring hospitalization for acute care. Participants were matched with historical controls based on case-mix, most responsible diagnosis, and level of complexity. INTERVENTIONS: Placement in the home-based intermediate care program. Daily home visits from the nurse practitioner and 24-hour access to care by telephone. MAIN OUTCOME MEASURES: Multivariate regression models were used to estimate the effect of the program on 5 outcomes: length of stay in hospital, cost of care substituted for hospitalization (Canadian dollars), readmission for a related diagnosis, readmission for any diagnosis, and costs incurred by community home-care services for patients following discharge from hospital. RESULTS: The outcomes of 43 hospital admissions were matched with those of 363 controls. Patients enrolled in the program stayed longer in hospital (coefficient 3.3 days, P < .001), used more community care services following discharge (coefficient $729, P = .007), and were more likely to be readmitted to hospital within 3 months of discharge (coefficient 17%, P = .012) than patients treated in hospital. Total substituted costs of home-based care were not significantly different from the costs of hospitalization (coefficient -$501, P = .11). CONCLUSION: While estimated cost savings were not statistically significant, the limitations of our study suggest that we underestimated these savings. In particular, the economic inefficiencies of a small immature program and the inability to control for certain factors when selecting historical controls affected our results. Further research is needed to determine the economic effect of mature home-based programs.
OBJECTIVE: To explore whether a home-based intermediate care program in a large Canadian city lowers the cost of care and to look at whether such home-based programs could be a solution to the increasing demands on Canadian hospitals. DESIGN: Single-arm study with historical controls. SETTING: Department of Family Medicine at the Ottawa Hospital (Civic campus) in Ontario. PARTICIPANTS: Patients requiring hospitalization for acute care. Participants were matched with historical controls based on case-mix, most responsible diagnosis, and level of complexity. INTERVENTIONS: Placement in the home-based intermediate care program. Daily home visits from the nurse practitioner and 24-hour access to care by telephone. MAIN OUTCOME MEASURES: Multivariate regression models were used to estimate the effect of the program on 5 outcomes: length of stay in hospital, cost of care substituted for hospitalization (Canadian dollars), readmission for a related diagnosis, readmission for any diagnosis, and costs incurred by community home-care services for patients following discharge from hospital. RESULTS: The outcomes of 43 hospital admissions were matched with those of 363 controls. Patients enrolled in the program stayed longer in hospital (coefficient 3.3 days, P < .001), used more community care services following discharge (coefficient $729, P = .007), and were more likely to be readmitted to hospital within 3 months of discharge (coefficient 17%, P = .012) than patients treated in hospital. Total substituted costs of home-based care were not significantly different from the costs of hospitalization (coefficient -$501, P = .11). CONCLUSION: While estimated cost savings were not statistically significant, the limitations of our study suggest that we underestimated these savings. In particular, the economic inefficiencies of a small immature program and the inability to control for certain factors when selecting historical controls affected our results. Further research is needed to determine the economic effect of mature home-based programs.
Authors: Moira Stewart; John F Sangster; Bridget L Ryan; Jeffrey S Hoch; Irene Cohen; Carol L McWilliam; Joan Mitchell; Evelyn Vingilis; Christine Tyrrell; Ian R McWhinney Journal: Can Fam Physician Date: 2010-11 Impact factor: 3.275
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Authors: Nicole Mittmann; Ning Liu; Joan Porter; Soo Jin Seung; Pierre K Isogai; Refik Saskin; Matthew C Cheung; Natasha B Leighl; Jeffrey S Hoch; Maureen Trudeau; William K Evans; Katie N Dainty; Craig C Earle Journal: CMAJ Open Date: 2014-02-04
Authors: Lian Leng Low; Farhad Fakhrudin Vasanwala; Lee Beng Ng; Cynthia Chen; Kheng Hock Lee; Shu Yun Tan Journal: BMC Health Serv Res Date: 2015-03-14 Impact factor: 2.655
Authors: Duygu Sezgin; Rónán O'Caoimh; Aaron Liew; Mark R O'Donovan; Maddelena Illario; Mohamed A Salem; Siobhán Kennelly; Ana María Carriazo; Luz Lopez-Samaniego; Cristina Arnal Carda; Rafael Rodriguez-Acuña; Marco Inzitari; Teija Hammar; Anne Hendry Journal: Eur Geriatr Med Date: 2020-08-04 Impact factor: 1.710