Interdisciplinary collaboration and computer-assisted home healthcare referral in the emergency department: a retrospective cohort study

Abstract

Aim Home healthcare (HHC) provides continuous care for disabled patients. However, HHC referral after the emergency department (ED) discharge remains unclear. Thus, this study aimed its clarification. Methods A computer-assisted HHC referral by interdisciplinary collaboration among emergency physicians, case managers, nurse practitioners, geriatricians, and HHC nurses was built in a tertiary medical center in Taiwan. Patients who had HHC referrals after ED discharge between February 1, 2020 and September 31, 2020, were recruited into the study. A non-ED HHC cohort who had HHC referrals after hospitalization from the ED was also identified. Comparison for clinical characteristics and uses of medical resources was performed between ED HHC and non-ED HHC cohorts. Results The model was successfully implemented. In total, 34 patients with ED HHC and 40 patients with non-ED HHC were recruited into the study. The female proportion was 61.8% and 67.5%, and the mean age was 81.5 and 83.7 years in ED HHC and non-ED HHC cohorts, respectively. No significant difference was found in sex, age, underlying comorbidities, and ED diagnoses between the two cohorts. The ED HHC cohort had a lower median total medical expenditure within 3 months (34,030.0 vs. 56,624.0 New Taiwan Dollars, p = 0.021) compared with the non-ED HHC cohort. Compared to the non-ED HHC cohort, the ED HHC cohort had a lower ≤ 1 month ED visit, ≤ 6 months ED visit, and ≤ 3 months hospitalization; however, differences were not significant. Conclusion An innovative ED HHC model was successfully implemented. Further studies with more patients are warranted to investigate the impact. Supplementary Information The online version contains supplementary material available at 10.1007/s40520-022-02109-9.

Implementation of a novel computer assisted telephone follow-up model for older patients after emergency department discharge in an Asian population

“…The case management system also enhances the e ciency of TCN, allowing her to save more time while providing better patient care. This method has been proven to be effective in our previous implementation of home healthcare referrals after ED discharge [9]. The concept of computer-based referral for clinical practice was proposed as early as 1999 [15].…”

“…In response to these challenges, the Chi Mei Medical Center (CMMC) established a geriatric ED in 2019 to enhance the quality of care for older ED patients [8]. Various geriatric care protocols have been implemented and published, encompassing hospice and palliative care, geriatric syndrome screening, medication reconciliation, delirium screening, treatment, and referrals for home healthcare [9][10][11][12][13][14]. Within this context, we developed a novel computer-assisted model for TFU and conducted this study to elucidate its impact on the Asian population.…”

Prediction of emergency department visits in home healthcare patients: a case-control study in Taiwan

“…Since 2017, the CMMC initiated HHC and has provided continuous and holistic care to its patients [12]. The HHC in CMMC includes not only the patients in need after hospital discharge but also those who are directly discharged from the ED [7]. We included all patients who received HHC between August 1, 2019, and July 31, 2021, in this study (Figure 1).…”

“…The aim of HHC is for aging in place as well as reducing ED visits and hospitalization [6]. ED visits during HHC are indicators of negative outcomes [2,7,8], which increases the burden on families and medical insurance. Previous studies reported that approximately 20-30% of patients who receive HHC may visit the ED or get hospitalized [8,9].…”

Impact of the Home-based Medical Integrated Program on Health Outcomes and Medical Resource Utilization in Taiwan

“…This change aims to encourage physicians to provide care outside of hospitals, expand options for seeking medical assistance, and promote changes in patients' health-seeking behavior [6,7]. The HMIP model integrates health literacy, rehabilitation, home-based medical care, home-based nursing, community palliative care, and end-of-life care, while building community resources networks and providing high-quality community care services [6].…”