System-Level Effects of an Outreach Service Focusing on Continuity of Care in Nursing Homes: A 12-Month Before and After Cost-Benefit Analysis.

Abstract

Aim: An ageing population increases the demand for emergency department (ED) visits and hospitalisations, and people living in nursing homes in particular are impacted by burdensome transfers and hospitalisations. As such, several onsite-provided care services have been developed to reduce hospitalisations, but more evidence of their cost-effectiveness is needed. An outreach service (OS) was thus developed for nursing homes to increase the quality of care and to decrease avoidable transfers of patients to ED examinations and treatments in hospitals by promoting continuity of care. The model consists of a patient-centred care plan followed by a responsible doctor, an easy-to-use patient information system, 24/7 geriatric teleconsultation for acute problems and nurse training. Thus, this mixed-methods study evaluates the system-level effects of the service model.

Methods: The study was conducted in 12 nursing homes, comprising 401 patients in total for both cohorts. The costs and benefits of the OS, including the use of health care services in other institutions, were analysed during the 12-month periods both before and after the implementation. An independent sample Mann-Whitney U-test was used at the patient level, and eight semi-structured interviews were conducted with the healthcare personnel concerning the benefits and challenges of the new model.

Results: The system-level costs decreased in all 12 nursing homes and, in total, 21.7% after the implementation. The biggest monetary savings were accrued from inpatient stays, both in primary and secondary care, as the new OS patients needed remarkably less frequent care in hospital ward units. Ambulance transfers and acute visits at primary care decreased by more than 50%, and patient-level decreases in total costs and in the costs of inpatient care and acute visits were all statistically significant (p < 0.01). Nurses and municipality officials considered the OS to be invariably positive.

Conclusions: The OS was effective, as it led to remarkable decreases in system-level costs for society across nursing homes during the 12-month follow-up. Nurses appreciated the OS, as it improved their ability to maintain control over their work.