Economic evidence with respect to cost-effectiveness of the transitional care model among geriatric patients discharged from hospital to home: a systematic review

Abstract

Background The German hospital-to-home discharge management of geriatric patients has long been criticized. The implementation of the American Transitional Care Model (TCM) could help to reduce readmissions and costs. The objective of this review was to check the scientific evidence of the cost-effectiveness of the TCM. Methods A systematic literature search in six databases for the time period of 26 years was conducted. The studies had to meet all pre-defined inclusion criteria. The data extraction is based on a criteria chart from literature. The methodological quality was assessed using the tools of the National Heart, Lung, and Blood Institute as well as the Consensus Health Economic Criteria list. The results transferability to German health care system was explained based on the criteria from the literature. Results Three American studies met all criteria. They showed partial cost analyses but no full economic analyses. It could be assumed that the economic effect of the TCM changes over time. The costs of a care coordinator could not be determined because few detailed information was reported. The TCM may have negative consequences for hospitals. The results are not transferable to Germany. Conclusion There is no scientific evidence for the cost-effectiveness of the defined TCM. The optimal TCM duration still needs to be clarified. A detailed overview with units and prices and an additional consideration of the hospital perspective could help to make the information more transparent when deciding about the TCM implementation. A full economic analysis under German conditions or for similar European countries is necessary.

Virtual wards: a rapid evidence synthesis and implications for the care of older people

“…Supporting evidence is drawn from seven other syntheses including a review of reviews and four Cochrane reviews [ 11 , 16 , 17 , 19 , 21 , 25 , 29 , 30 ]. We also checked a review of transitional care arrangements for relevant information [ 33 ]. Most of the additional evidence identified related to costs rather than to cost-effectiveness.…”

Evidências de efetividade dos cuidados de transição em idosos após internação hospitalar: uma revisão sistemática rápida

“…Todos os artigos incluídos descreveram um modelo de cuidados de transição de alta hospitalar envolvendo regime terapêutico, seguimento por equipe multiprofissional e ferramentas de comunicação pré-estabelecida ( 17 - 23 , 25 , 27 - 32 ). Os estudos apresentaram, como principais estratégias, o contato telefônico ( 17 , 28 , 20 , 22 - 25 , 29 , 30 , 33 ); visitas domiciliares ( 20 , 22 - 25 , 28 - 30 , 33 ); e material impresso educativo ( 17 ). A tabela 2 descreve as características dos estudos incluídos.…”

“…Em relação ao tempo de seguimento após a alta hospitalar, a média foi de 6 meses. Entretanto, algumas revisões apresentaram um acompanhamento mais longo, de 1 ano e até 3 anos ( 20 , 21 , 23 , 30 , 33 ).…”

Assessment of the Impact of Home-Based Hospitalization on Health Outcomes: An Observational Study

“…11 The impact and efficiency of HBH have been widely researched in previous studies for distinct conditions: cancer, 2 chronic obstructive pulmonary disease, [12][13][14][15][16][17] COVID-19, 3,8 stroke, 18,19 neuromuscular diseases, 20 heart failure, 17,[21][22][23][24][25] diabetes, 26 among others. 7,27,28 The impact and efficiency of HBH were also analyzed in different groups (e.g., geriatric, 5,[28][29][30] , adult 17 and pediatric 31 populations) and various countries (e.g., Italy, 25 Spain, 21,32 Sweden, 23 Singapore, 33 United Kingdom, 30,34 the United States 3,6,17 ), with a focus on specific clinical issues (e.g., ulcer area, 26 changes in forced expiratory volume in one second 13 ) and diverse outcomes (e.g., mortality, 4,24,35 LOS 5,7,30 ), as well as costs.…”

“…7,27,28 The impact and efficiency of HBH were also analyzed in different groups (e.g., geriatric, 5,[28][29][30] , adult 17 and pediatric 31 populations) and various countries (e.g., Italy, 25 Spain, 21,32 Sweden, 23 Singapore, 33 United Kingdom, 30,34 the United States 3,6,17 ), with a focus on specific clinical issues (e.g., ulcer area, 26 changes in forced expiratory volume in one second 13 ) and diverse outcomes (e.g., mortality, 4,24,35 LOS 5,7,30 ), as well as costs. 4,17,29,34 Although HBH has been associated with saving costs and improved health outcomes, this model does not seem to represent the change in care burden. 4 A recent metaanalysis suggests that patients with chronic conditions who presented to the emergency department and were treated with HBH interventions had a reduced risk of hospital readmission and long-term care admission compared to those who received CH.…”