The Value of Admission Avoidance: Cost-Consequence Analysis of One-Year Activity in a Consolidated Service

Abstract

Background: Many advantages of hospital at home (HaH), as a modality of acute care, have been highlighted, but controversies exist regarding the cost-benefit trade-offs. Objective: To assess health outcomes and analytical costs of hospital avoidance (HaH-HA) in a consolidated service with over ten years of delivery of HaH in Barcelona (Spain). Methods: A retrospective cost-consequence analysis of all first episodes of HaH-HA, directly admitted from the emergency room (ER) between 2017 and 2018, was carried out. HaH-HA was compared with a propensity-score-matched group of contemporary patients admitted to conventional hospitalization (Controls). Mortality, re-admissions, ER visits, and direct healthcare costs were evaluated. Registration: ClinicalTrials.gov (26/04/2017;NCT03130283). Results: HaH-HA and Controls (n=441 each) were comparable in terms of age (73 [SD16] vs 74 [16]), gender (male, 57% vs 59%), multimorbidity, healthcare expenditure during the previous year, case mix index of the acute episode, and main diagnosis at discharge. HaH-HA presented lower mortality during the episode (0 vs. 19 (4.3%); p < 0.001). At 30 days post-discharge, HaH-HA and Controls showed similar re-admission rates; however, ER visits were lower in HaH-HA than in Controls (28 (6.3%) vs 34 (8.1%); p = 0.044). Average costs per patient during the episode were lower in the HaH-HA group (1,078 EUR) than in Controls (2,171 EUR). Likewise, healthcare costs within the 30 days post-discharge were also lower in HaH-Ha than in Controls (p < 0.001). Conclusions: The study showed higher performance and cost reductions of HaH-HA in a real-world setting. The identification of sources of savings facilitates scaling of hospital avoidance. Funding: This article was funded by JADECARE project- HP-JA-2019 - Grant Agreement number 951442 (2020-2023), a European Union Health Program 2014-2020. Keywords: Hospital at home; Early readmissions; Health Services Research; Implementation science; Transitional Care.

Five years of Hospital at Home adoption in Catalonia: impact and challenges

“…As described above, all economic calculations in the current study were based on expenditure data. 31 However, we believe that the characteristics of the study design and the availability of clinical and analytical data from the area 32,33 positively influenced the analyses carried out in the current research and facilitated recommendations for enhancing the quality of service delivery that can be generalized to other integrated care services.…”

“…A recently reported contemporary assessment of analytical costs in the Hospital Clinic of Barcelona, one of the leading public healthcare providers in the area, demonstrated that AA generates substantial savings, reducing operational costs by half, mainly due to personnel and structure costs. 32,33 In this regard, it must be emphasized that expenses during the episode of AA, based on APR-DRGs, do not correspond with the operational costs of the intervention. The expert group agreed that the implementation of analytical accounting should be extended to all providers to build up adequate reimbursement strategies.…”

“…Besides the baseline and episode characteristics, we gathered information regarding healthcare expenditure, hospitalizations, and visits to the emergency room within the 30- and 90-days period after discharge. Expenditure information was obtained from reimbursements by the Catalan Health Service, 31 since no operational costs 32,33 were available for the entire study group. AA delivery is reimbursed as a specific healthcare service, with case costs estimated based on the APR-DRG categories of the main diagnostic, whereas ESD is considered part of conventional hospitalizations in terms of reimbursement.…”

Five years of Hospital at Home adoption in Catalonia: impact and challenges

“…As described above, all economic calculations in the current study were based on expenditure data. 32 However, we believe that the characteristics of the study design and the availability of clinical and analytical data from the area 33,34 positively in uenced the analyses carried out in the current research and facilitated recommendations for enhancing the quality of service delivery that can be generalized to other integrated care services.…”

“…Expenditure information was obtained from reimbursements by the Catalan Health Service, 32 since no operational costs 33,34 were available for the entire study group. HaH delivery is reimbursed as a speci c healthcare service, with case costs estimated based on the APR-DRG categories of the main diagnostic.…”