Integrated care facilitation for older patients with complex health care needs reduces hospital demand

Abstract

Objective: The evaluation of a new model of care for older people with complex health care needs that aimed to reduce their use of acute hospital services. Method:Older people (over 55 years) with complex health care needs, who had made three or more presentations to a hospital emergency department (ED) in the previous 12 months, or who were identified by community health care agencies as being at risk of making frequent ED presentations, were recruited to the project. The participants were allocated a "care facilitator" who provided assistance in identifying and accessing required health care services, as well as education in aspects of self management. Data for the patients who had been participants on the project for a minimum of 90 days (n = 231) were analysed for their use of acute hospital services (ED presentations, admissions and hospital bed-days) for the period 12-months pre-recruitment and postrecruitment. A similar analysis on the use of hospital services was conducted on the data of patients who were eligible and who had been offered participation, but who had declined (comparator group; n = 85).Results: Post recruitment, the recruited patients displayed a 20.8% reduction in ED presentations, a 27.9% reduction in hospital admissions, and a 19.2% reduction in bed-days. By comparison, the patients who declined recruitment displayed a 5.2% increase in ED presentations, a 4.4 % reduction in hospital admissions, and a 15.3% increase in inpatient bed-days over a similar timeframe. Conclusion

Effectiveness of Organizational Interventions to Reduce Emergency Department Utilization: A Systematic Review

“…There were three randomized controlled trials [45], [47], [48], one quasi-experimental study with a control group [49], one quasi-experimental study without a control group [50], and one case-control study [46]. Two studies were from Australia [47], [49], and the rest of the studies were from the US [45], [46], [48], [50].…”

Motives for self-referral to the emergency department: a systematic review of the literature

“…In one study, performed in the USA, people received a booklet with general information on when to visit an ED, but this did not show a significant effect on the number of ED-visits [41]. Education directed at specific conditions (ear pain in children, diabetes, asthma) and more intensive programs for geriatric or older, chronically ill patients have shown mixed results [42–47]. The effect of telephone consultation for patients to call for advice about their current health symptoms prior to seeking treatment at the ED also seems insufficient.…”

Pattern of inappropriate cases presenting to the Accident and Emergency Department in a Nigeria Tertiary Hospital

“…25 Bird et al similarly reported a 20.8% reduction in AED visits after educating patients in aspects of self-management. 26 These reductions could be due to inappropriate users of the facilities seeking alternative sources of care such as primary health centres, community pharmacists and general practitioners. Considering the small population of physicians in Nigeria, educational intervention has to be the duty of all health care providers to avoid physicians being overwhelmed by the large number of patients.…”