Pamela Nadash1,2, Marc A Cohen1,2,3, Jane Tavares1,2, Edward Alan Miller1,2,4. 1. Department of Gerontology and Gerontology Institute, John W. McCormack Graduate School of Policy and Global Studies, University of Massachusetts Boston, Boston, Massachusetts, USA. 2. Leading Age Center for Long-Term Services & Supports @UMass Boston, John W. McCormack Graduate School of Policy and Global Studies, University of Massachusetts Boston, Boston, Massachusetts, USA. 3. Center for Consumer Engagement and Health System Transformation, Community Catalyst, Boston, Massachusetts, USA. 4. Department of Health Services, Policy and Practice and Center for Gerontology and Health Care Research, School of Public Health, Brown University, Providence, Rhode Island, USA.
Abstract
OBJECTIVE: To test the impact of placing a wellness team (nurse and social worker) in senior housing on ambulance transfers and visits to emergency departments over 18 months. DATA SOURCES/STUDY SETTING: Intervention sites included seven Boston-area buildings, with five buildings at comparable settings acting as controls. Data derive from building-level ambulance data from emergency responders; building-level Medicare claims data on emergency department utilization; and individual-level baseline assessment data from participants in the intervention (n = 353) and control (n = 208) sites. STUDY DESIGN: We used a pre/postdifference in difference quasi-experimental design applying several analytic methods. The preintervention period was January 2016-March 2017, while the intervention period was July 2017-December 2018. DATA COLLECTION/EXTRACTION METHODS: Emergency responders provided aggregate transfer data on a daily basis for intervention and control buildings; the Quality Improvement Organization provided quarterly aggregate data on emergency department visit rates; and assessment data came from a modified Vitalize 360 assessment and coaching tool. PRINCIPAL FINDINGS: The study found an 18.2% statistically significant decline in ambulance transfers in intervention buildings, with greater declines in buildings that had fewer services available at baseline, compared to other intervention sites. Analysis of Medicare claims data, adjusted for the proportion of residents over 75 per building, found fewer visits to emergency departments in intervention buildings. CONCLUSIONS: Health-related supports in senior housing sites can be effective in reducing emergency transfers and visits to emergency departments.
OBJECTIVE: To test the impact of placing a wellness team (nurse and social worker) in senior housing on ambulance transfers and visits to emergency departments over 18 months. DATA SOURCES/STUDY SETTING: Intervention sites included seven Boston-area buildings, with five buildings at comparable settings acting as controls. Data derive from building-level ambulance data from emergency responders; building-level Medicare claims data on emergency department utilization; and individual-level baseline assessment data from participants in the intervention (n = 353) and control (n = 208) sites. STUDY DESIGN: We used a pre/postdifference in difference quasi-experimental design applying several analytic methods. The preintervention period was January 2016-March 2017, while the intervention period was July 2017-December 2018. DATA COLLECTION/EXTRACTION METHODS: Emergency responders provided aggregate transfer data on a daily basis for intervention and control buildings; the Quality Improvement Organization provided quarterly aggregate data on emergency department visit rates; and assessment data came from a modified Vitalize 360 assessment and coaching tool. PRINCIPAL FINDINGS: The study found an 18.2% statistically significant decline in ambulance transfers in intervention buildings, with greater declines in buildings that had fewer services available at baseline, compared to other intervention sites. Analysis of Medicare claims data, adjusted for the proportion of residents over 75 per building, found fewer visits to emergency departments in intervention buildings. CONCLUSIONS: Health-related supports in senior housing sites can be effective in reducing emergency transfers and visits to emergency departments.
Authors: Manish N Shah; Matthew M Hollander; Courtney Mc Jones; Thomas V Caprio; Yeates Conwell; Jeremy T Cushman; Eva H DuGoff; Amy J H Kind; Michael Lohmeier; Ranran Mi; Eric A Coleman Journal: J Am Geriatr Soc Date: 2018-08-10 Impact factor: 5.562
Authors: Julie P W Bynum; Alice Andrews; Sandra Sharp; Dennis McCollough; John E Wennberg Journal: Health Aff (Millwood) Date: 2011-05 Impact factor: 6.301
Authors: Manish N Shah; Jeffrey J Bazarian; E Brooke Lerner; Rollin J Fairbanks; William H Barker; Peggy Auinger; Bruce Friedman Journal: Acad Emerg Med Date: 2007-05 Impact factor: 3.451