Kerman University of Medical Sciences International Journal of Health Policy and Management 2322-5939 11 12 2022 12 01 Impact of the Timing of Integrated Home Palliative Care Enrolment on Emergency Department Visits 2964 2971 4257 10.34172/ijhpm.2022.5783 EN Alessandro Scacchi Department of Public Health and Paediatrics, University of Turin, Torino, Italy 0000-0002-5575-944X Armando Savatteri Department of Public Health and Paediatrics, University of Turin, Torino, Italy 0000-0002-2234-108X Gianfranco Politano Department of Control and Computer Engineering, Politecnico di Torino, Torino, Italy 0000-0001-5268-9899 Alessio Conti Department of Public Health and Paediatrics, University of Turin, Torino, Italy 0000-0003-4301-8924 Marco Dalmasso Epidemiology Unit, Local Health Unit TO3, Grugliasco, Italy Sara Campagna Department of Public Health and Paediatrics, University of Turin, Torino, Italy 0000-0003-2722-1818 Michela Maria Gianino Department of Public Health and Paediatrics, University of Turin, Torino, Italy 0000-0003-4239-7475 Journal Article 2020 12 10 Background The association between timing of integrated home palliative care (IHPC) enrolment and emergency department (ED) visits is still under debate, and no studies investigated the effect of the timing of IHPC enrolment on ED visits, according to their level of emergency. This study aimed to investigate the impact of the timing of IHPC enrolment on different acuity ED visits. Methods A retrospective, pre-/post-intervention study was conducted from 2013 to 2019 in Italy. Analyses were stratified by IHPC duration (short ≤30 days; medium 31-90 days; long >90 days) and triage tags (white/green: low level of emergency visit; yellow/red: medium-to-high level). The impact of the timing of IHPC enrolment was evaluated in two ways: incidence rate ratios (IRRs) of ED visits were determined (1) before and after IHPC enrolment in each group and (2) post-IHPC among groups. Results A cohort of 17 983 patients was analysed. Patients enrolled early in the IHPC programme had a significantly lower incidence rate of ED visits than the pre-enrolment period (IRR = 0.65). The incidence rates of white/green and yellow/red ED visits were significantly lower post-IHPC enrolment for patients enrolled early (IRR = 0.63 and 0.67, respectively). All results were statistically significant (P < .001). Comparing the IHPC groups after enrolment versus the short group, medium and long IHPC groups had a significant reduction of ED visits (IRR = 0.37, IRR = 0.14 respectively), showing a relation between the timing of IHPC enrolment and the incidence of ED visits. A similar trend was observed after accounting for triage tags of ED visits. Conclusion The timing of IHPC enrolment is related with a variation of the incidence of ED visits. Early IHPC enrolment is related to a high significant reduction of ED visits when compared to the 90-day pre-IHPC enrolment period and to late IHPC enrolment, accounting for both low-level and medium-to-high level emergency ED visits.

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