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

References

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International Journal of Health Policy and Management
Volume 11, Issue 12
December 2022
Pages 3012-3018

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History

  • Receive Date: 29 July 2021
  • Revise Date: 22 March 2022
  • Accept Date: 15 May 2022
  • First Publish Date: 16 May 2022

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