Emergency Department Visits Before, After and During Integrated Home Care: A Time Series Analyses in Italy

Document Type : Original Article

Authors

1 Department of Public Health and Pediatrics, University of Torino, Torino, Italy

2 Department of Clinical and Biological Sciences, University of Torino, Torino, Italy

Abstract

Background 
Integrated home care (IHC) is one strategy to provide care to people with multiple chronic conditions, and it contributes to the reduction of unnecessary emergency department (ED) use, but there are conflicting results on its effectiveness. In this study, we assessed the frequency and characteristics of ED visits occurring before, during, and after IHC in a large cohort of IHC patients enrolled over 6 years.

Methods 
The analysis included 39 822 IHC patients identified in Italian administrative databases. Patients were grouped in tertiles according to IHC duration (short, intermediate, and long) and the number of ED visits during IHC was compared to that the 12 months before IHC enrolment and in the 12 months after IHC discharge across IHC duration groups.

Results 
We observed a reduction in ED visits during IHC. IHC was significantly associated with a reduction in ED visits in the long and short IHC duration groups. A non-significant reduction in ED visits was observed in the intermediate IHC duration group. A 90% reduction in ED visits during IHC and a 45% reduction after IHC was observed in the short IHC duration group. Corresponding reductions were 17% and 64% during and after IHC, respectively, in the long IHC duration group.

Conclusion 
IHC was effective in reducing ED visits, but expansion of IHC to include additional necessary services could further reduce ED visits. Investment in the creation of a structured, effective network of engaged professionals (including community care services and hospitals) is crucial to achieving this.

Keywords


  1. Nie JX, Wang L, Tracy CS, Moineddin R, Upshur RE. Health care service utilization among the elderly: findings from the Study to Understand the Chronic Condition Experience of the Elderly and the Disabled (SUCCEED project). J Eval Clin Pract. 2008;14(6):1044-1049. doi:1111/j.1365-2753.2008.00952.x
  2. Tarricone R, Tsouros AD. The Solid Facts: Home Care in Europe. Copenhagen: WHO Regional Office for Europe; 2008.
  3. Deliberazione della Giunta Regionale. Linee guida per l’attivazione del Servizio di Cure domiciliari nelle Aziende Sanitarie Locali della Regione Piemonte. Vol Bollettino Ufficiale della Regione Piemonte; 2020:22. http://www.regione.piemonte.it/governo/bollettino/abbonati/2002/22/siste/00000141.htm. Accessed January 13, 2021.
  4. Corsello G, Ferrara P, Chiamenti G, Nigri L, Campanozzi A, Pettoello-Mantovani M. The child health care system in Italy. J Pediatr. 2016;177S:S116-S126. doi:1016/j.jpeds.2016.04.048
  5. Ministero della Salute. Nuova caratterizzazione dell’assistenza territoriale domiciliare e degli interventi ospedalieri a domicilio. http://www.salute.gov.it/imgs/C_17_pubblicazioni_572_allegato.pdf. Published 2006.
  6. Ruiz S, Snyder LP, Rotondo C, Cross-Barnet C, Colligan EM, Giuriceo K. Innovative home visit models associated with reductions in costs, hospitalizations, and emergency department use. Health Aff (Millwood). 2017;36(3):425-432. doi:1377/hlthaff.2016.1305
  7. Lubitz J, Cai L, Kramarow E, Lentzner H. Health, life expectancy, and health care spending among the elderly. N Engl J Med. 2003;349(11):1048-1055. doi:1056/NEJMsa020614
  8. Stall N, Nowaczynski M, Sinha SK. Systematic review of outcomes from home-based primary care programs for homebound older adults. J Am Geriatr Soc. 2014;62(12):2243-2251. doi:1111/jgs.13088
  9. Carter R, Riverin B, Levesque JF, Gariepy G, Quesnel-Vallée A. The impact of primary care reform on health system performance in Canada: a systematic review. BMC Health Serv Res. 2016;16:324. doi:1186/s12913-016-1571-7
  10. Godwin M, Gadag V, Pike A, et al. A randomized controlled trial of the effect of an intensive 1-year care management program on measures of health status in independent, community-living old elderly: the Eldercare project. Fam Pract. 2016;33(1):37-41. doi:1093/fampra/cmv089
  11. Jones A, Schumacher C, Bronskill SE, et al. The association between home care visits and same-day emergency department use: a case-crossover study. CMAJ. 2018;190(17):E525-E531. doi:1503/cmaj.170892
  12. McGregor MJ, Cox MB, Slater JM, et al. A before-after study of hospital use in two frail populations receiving different home-based services over the same time in Vancouver, Canada. BMC Health Serv Res. 2018;18(1):248. doi:1186/s12913-018-3040-y
  13. Stephenson MD, Lisy K, Stern CJ, Feyer AM, Fisher L, Aromataris EC. The impact of integrated care for people with chronic conditions on hospital and emergency department utilization: a rapid review. Int J Evid Based Healthc. 2019;17(1):14-26. doi:1097/xeb.0000000000000151
  14. Campagna S, Borraccino A, Politano G, et al. Determinants associated with the risk of emergency department visits among patients receiving integrated home care services: a 6-year retrospective observational study in a large Italian region. Int J Health Policy Manag. 2021;10(10):605-612. doi:34172/ijhpm.2020.79
  15. Resident population on 1st January. http://dati.istat.it/Index.aspx?QueryId=18460&lang=en. Accessed July 6, 2020. Published 2020.
  16. Penfold RB, Zhang F. Use of interrupted time series analysis in evaluating health care quality improvements. Acad Pediatr. 2013;13(6 Suppl):S38-44. doi:1016/j.acap.2013.08.002
  17. R Core Team. R: A Language and Environment for Statistical Computing. Vienna, Austria: R Foundation for Statistical Computing; 2016.
  18. Booker MJ, Shaw AR, Purdy S. Why do patients with 'primary care sensitive' problems access ambulance services? A systematic mapping review of the literature. BMJ Open. 2015;5(5):e007726. doi:1136/bmjopen-2015-007726
  19. Di Pollina L, Guessous I, Petoud V, et al. Integrated care at home reduces unnecessary hospitalizations of community-dwelling frail older adults: a prospective controlled trial. BMC Geriatr. 2017;17(1):53. doi:1186/s12877-017-0449-9
  20. Coppa D, Winchester SB, Roberts MB. Home-based nurse practitioners demonstrate reductions in rehospitalizations and emergency department visits in a clinically complex patient population through an academic-clinical partnership. J Am Assoc Nurse Pract. 2018;30(6):335-343. doi:1097/jxx.0000000000000060
  21. Barbadoro P, Di Tondo E, Menditto VG, et al. Emergency department non-urgent visits and hospital readmissions are associated with different socio-economic variables in Italy. PLoS One. 2015;10(6):e0127823. doi:1371/journal.pone.0127823
  22. Doheny M, Agerholm J, Orsini N, Schön P, Burström B. Socio-demographic differences in the frequent use of emergency department care by older persons: a population-based study in Stockholm county. BMC Health Serv Res. 2019;19(1):202. doi:1186/s12913-019-4029-x
  23. Yang M, Thomas J, Zimmer R, Cleveland M, Hayashi JL, Colburn JL. Ten things every geriatrician should know about house calls. J Am Geriatr Soc. 2019;67(1):139-144. doi:1111/jgs.15670
  24. McGeoch G, Shand B, Gullery C, Hamilton G, Reid M. Hospital avoidance: an integrated community system to reduce acute hospital demand. Prim Health Care Res Dev. 2019;20:e144. doi:1017/s1463423619000756
  25. Governo Italiano. Piano nazionale di ripresa e resilienza (PNRR). #NextGenerationEU. Approved by the EU commition the 22nd of June 2021. https://www.governo.it/sites/governo.it/files/PNRR.pdf. Published June 22, 2021.
  26. Basso I, Simionato L, Dimonte V, Scaglione S, Campagna S. The emergency department visits of nursing home residents: descriptive study in a Nursing Home. Assist Inferm Ric. 2018;37(2):68-75. doi:1702/2940.29552
  27. Gruneir A, Bell CM, Bronskill SE, Schull M, Anderson GM, Rochon PA. Frequency and pattern of emergency department visits by long-term care residents--a population-based study. J Am Geriatr Soc. 2010;58(3):510-517. doi:1111/j.1532-5415.2010.02736.x
  28. Salvi F, Mattioli A, Giannini E, et al. Pattern of use and presenting complaints of older patients visiting an Emergency Department in Italy. Aging Clin Exp Res. 2013;25(5):583-590. doi:1007/s40520-013-0112-z
  29. Noli M. 2. I servizi domiciliari. L’assistenza agli anziani non autosufficienti in Italia. http://www.irisonline.it/web/images/7dicembre2020/nna_2020_7%B0_rapporto.pdf. Published 2021.
  30. Guzzo PP, La Spina A. Sistemi di welfare domiciliare nel Sud Europa: Italia e Grecia in prospettiva comparata. Autonomie locali e servizi sociali. 2019;42(3):443-63.
  31. Gazzetta Ufficiale. DL 34/2020. Vol 128. 2020. https://www.gazzettaufficiale.it/eli/id/2020/05/19/20G00052/sg. Accessed December 6, 2021.
  32. Regione Piemonte. DGR 41-5952. Linee guida per l’attivazione del Servizio di Cure domiciliari nelle Aziende Sanitarie Locali della Regione Piemonte. http://www.regione.piemonte.it/governo/bollettino/abbonati/2002/22/siste/00000141.htm. Published May 30, 2002.

Articles in Press, Corrected Proof
Available Online from 16 May 2022
  • Receive Date: 29 July 2021
  • Revise Date: 22 March 2022
  • Accept Date: 15 May 2022
  • First Publish Date: 16 May 2022