Cost comparison of unplanned hospital admissions from care home and community settings: A retrospective cohort study using routinely collected linked data

Abstract

People living in care homes often have multiple morbidities and complex healthcare needs, potentially leading to more frequent healthcare utilisation (planned and unplanned) and increased costs. Unscheduled hospital attendance from a care home setting is often regarded as system failure, futile and inefficient in terms of resource use. However, there is a lack of evidence on the costs associated with these attendances. This retrospective cohort study aims to estimate these costs and provides a comparison by usual place of residence. Data were obtained from NHS Greater Glasgow and Clyde Safe Haven reference datasets. Individual-level record linkage between Trak ED, recording emergency admissions, and other routine healthcare datasets was carried out. Healthcare costs were estimated using a two-part model. The first part used a probit model to estimate the probability of positive healthcare resource utilisation, and the second part used a GLM to estimate costs, conditional on costs being positive. Annual mean costs were higher for care home residents than community-dwellers overall and in both men and women and all deprivation quintiles. No significant difference in costs was observed for care home residents who were younger than 65 years and those with no comorbidity. Our results indicate a notable increase in healthcare expenditure for individuals residing in care homes compared to those living in the community following unplanned acute care incidents, emphasising the importance of developing interventions that are specifically designed to meet the unique requirements of this demographic.