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

Abstract

<jats:p> <jats:bold>Background:</jats:bold> Allowing patients to remain at home and decreasing the number of unnecessary emergency room visits have become important policy goals in modern healthcare systems. However, the lack of available literature makes it critical to identify determinants that could be associated with increased emergency department (ED) visits in patients receiving integrated home care (IHC). <jats:bold>Methods:</jats:bold> A retrospective observational study was carried out in a large Italian region among patients with at least one IHC event between January 1, 2012 and December 31, 2017. IHC is administered from 8 am to 8 pm by a team of physicians, nurses, and other professionals as needed based on the patient’s health conditions. A clinical record is opened at the time a patient is enrolled in IHC and closed after the last service is provided. Every such clinical record was defined as an IHC event, and only ED visits that occurred during IHC events were considered. Sociodemographic, clinical and IHC variables were collected. A multivariate, stepwise logistic analysis was then performed, using likelihood of ED visit as a dependent variable. <jats:bold>Results:</jats:bold> A total of 29 209 ED visits were recorded during the 66 433 IHC events that took place during the observation period. There was an increased risk of ED visits in males (odds ratio [OR]=1.29), younger patients, those with a family caregiver (OR=1.13), and those with a higher number of cohabitant family members. Long travel distance from patients’ residence to the ED reduced the risk of ED visits. The risk of ED visits was higher when patients were referred to IHC by hospitals or residential facilities, compared to referrals by general practitioners. IHC events involving patients with neoplasms (OR=1.91) showed the highest risk of ED visits. <jats:bold>Conclusion:</jats:bold> Evidence of sociodemographic and clinical determinants of ED visits may offer IHC service providers a useful perspective to implement intervention programmes based on appropriate individual care plans and broad-based client assessment.</jats:p>

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

“…Furthermore, about a quarter of ED visits in our sample did not result in a formal diagnosis. As shown in a previous work, patients usually visit the ED for baseline clinical conditions 14 . Due to the lack of diagnostic instrumentation and communication issues while in home care, IHC teams cannot determine the possible risk of mild or undefined symptoms, and their ability to identify and manage more critical situations is limited.…”

“…Further details on the databases used and the sampling procedure can be found in the parent study. 14 Patients enrolled in home care models other than IHC (eg, programmed home care or palliative home care) were excluded. If a patient had more than one IHC episode during the enrolment period, only the first episode was considered.…”

“…7,8 Although promising, results vary on the effectiveness of home care services to reduce ED visits. [9][10][11][12][13][14] For example, Jones et al reported that ED visits increased following sameday nursing home care visits. 11 However, to the best of our knowledge, there are no large, long-term, population-based studies comparing ED visits before, during, and after IHC.…”

Emergency-department accesses in home care paediatric patients: Occurrence and risks of use in a six-year retrospective investigation in Northern Italy

“…Both the numbers and the demand for home health care services are indeed increasing. As also evidenced in the adult population [31], the recent technological advances in medical care had both allowed children with complex medical problems to have a higher life expectancy, and increased health services demand. Although more high-quality prospective studies are needed, the use of IPHC duration could represent an indirect measure of the complexity of care.…”

Factors Associated With Emergency Department Visits Among Patients Receiving Publicly-funded Homecare Services: A Retrospective Chart Review From Southern Taiwan Regional Hospital

“…Although the public health strategy of increased accessibility of comprehensive home or community-based healthcare services and emergency home visits have been commonly adopted to reduce overcrowding of emergency departments (EDs), [5][6][7][8][9][10][11][12][13] scientific evidence on the association between home-based healthcare services and ED usage is surprisingly insufficient and controversial. Provision of integrated homecare services has been shown to be beneficial for reducing inappropriate ED visits, 10,12,13 whereas contrary argument exhibits unplanned or nonurgent ED visits often occur among patients receiving homecare services.…”