The Effects of Preventive Home Visits on Older People’s Use of Health Care and Social Services and Related Costs

Abstract

Background We use data from a randomized controlled trial on preventive home visits exploring effectiveness on health-related quality of life. In this article, we examine the intervention’s cost-effectiveness and effects on quality-adjusted life years in older home-dwelling adults. Methods There were 422 independently home-dwelling participants in the randomized, controlled trial, all aged more than 75 years, with equal numbers in the control and intervention groups. The intervention took place in a municipality in Finland and consisted of multiprofessional preventive home visits. We gathered the data on health care and social services use from central registers and medical records during 1 year before the intervention and 2 years after the intervention. We analyzed the total health care and social services use and costs per person-years and the difference in change in health-related quality of life as measured using the 15D measure. We calculated quality-adjusted life years and incremental cost-effectiveness ratios. Results There was no significant difference in baseline use of services or in the total use and costs of health care and social services during the 2-year follow-up between the two groups. In the intervention group, health-related quality of life declined significantly more slowly compared with the control group (–0.015), but there was no significant difference in quality-adjusted life years gained between the groups. The cost-effectiveness plane showed 60% of incremental cost-effectiveness ratios lying in the dominant quadrant, representing additional effects with lower costs. Conclusions This multiprofessional preventive home visit intervention appears to have positive effects on health-related quality of life without accruing additional costs. The clinical trial registration number ACTRN12616001411437.

Comparison of community health nurses' preventive home visits to older adults in Sweden and Slovenia:

“…PHVs to older adults have a wide range of positive effects on patients and their families, which go beyond reducing societal costs (Zingmark, Norström, Lindholm, Dahlin-Ivanoff, & Gustafsson 2019), although some studies (Brettschneider et al, 2015;Liimatta, Lampela, Kautiainen, Laitinen-Parkkonen, & Pitkala, 2020) argue against their cost-utility. According to a Finnish study, PHVs provided by a multidisciplinary team have a positive effect only on health-related quality of life in older adults (Liimatta et al, 2020). For more successful PHVs, comprehensive geriatric assessment, follow-up visits, and a focus on the younger population are important (Tourigny et al, 2015).…”

LACE Score-Based Risk Management Tool for Long-Term Home Care Patients: A Proof-of-Concept Study in Taiwan

“…In home care settings, there is an ethical consideration for false negatives (no preventive measure for high-risk patients predicted as low-risk) and false positives. (overdone preventive measure for lowrisk patients predicted as high-risk) [30] As a result, ruling-out readmission is much more critical than ruling-in readmission in home care patients [31]. Since readmission reduction plan takes extra cost to the standard follow-up, ruling-out readmission (higher NPV and -LR, higher power to identify patients had a lower risk for readmission) can save the excessive cost of additional preventive measure to low-risk patients, and direct resources to high-risk ones [32,33].…”

Financial balance of home nursing care providers in the Czech Republic

“…However, much more important and sensible is the information that HNC can also save on care costs in addition to patient benefits. For example, home care provision had been demonstrated to be more effective and efficient than institutionalised care [23][24][25], home visits implemented by a multidisciplinary team appeared to help slow down the health-related quality of life among older adults [26] without accruing additional costs [27], and enhanced quality of life while not increasing the overall costs of health care [25]. In-home palliative team care was costeffective; it increased the chance of dying at home by 10%, increased the average number of days at home (6 days) and quality-adjusted life-days (0.5 days), and it reduced costs by approximately $4400 per patient [28].…”