P035: Impact of EMS direct referral to community care on emergency department utilization

Introduction: The Community Referral by Emergency Medical Services (CREMS) program was implemented in January 2015 in Southwestern Ontario. The program allows Paramedics interacting with a patient to directly refer those in need of home care support to their local Community Care Access Centre (CCAC) for needs assessment. If indicated, subsequent referrals are made to specific services (e.g. nursing, physiotherapy and geriatrics) by CCAC. Ideally, CREMS connects patients with appropriate, timely care, supporting individual needs. Previous literature has indicated CREMS results in an increase of home care services provided to patients. Methods: The primary objective of this project is to evaluate the impact of the CREMS program on Emergency Department utilization. Data for all CCAC referrals from London-Middlesex EMS was collected for a thirteen month period (February 2015-February 2016). For all patients receiving a new or increased service from CCAC the number of Emergency Department visits 2 years before referral and 2 years after referral were calculated. A related samples Wilcoxon Signed Rank Test was performed to examine the difference in ED visits pre and post referral to CCAC. Results: There were 213 individuals who received a new or increased service during the study timeframe. Median [IQR] patient age was 77 [70-85.5]. 113/213 (53%) of patients were female. The majority of patients 135/213 (63.4%) were a new referral to CCAC. The median [IQR] number of hospital visits before referral was 3 [1-5] and after referral was 2 [0-4]. There was no significant difference in the overall number of ED visits before versus after referral (955 vs 756 visits, p = 0.051). Conclusion: Community based care can improve patient experience and health outcomes. Paramedics are in a unique position to assess patients in their home to determine who might benefit from home care services. CREMS referrals for this patient group showed a trend towards decreased ED visits after referral but the trend was not statistically significant.

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Impact of the Outbreak of the COVID-19 Pandemic on Formal and Informal Care of Community-Dwelling Older Adults: Cross-National Clustering of Empirical Evidence from 23 Countries

Sustainability ◽

10.3390/su13137277 ◽

2021 ◽

Vol 13 (13) ◽

pp. 7277

Author(s):

Aviad Tur-Sinai ◽

Netta Bentur ◽

Paolo Fabbietti ◽

Giovanni Lamura

Keyword(s):

Older Adults ◽

Home Care ◽

Informal Care ◽

Home Care Services ◽

Community Dwelling ◽

European Countries ◽

Care Services ◽

The Impact ◽

Community Dwelling Older Adults ◽

Informal Help

The COVID-19 pandemic has been dramatically affecting the life of older adults with care needs and their family caregivers. This study illustrates how the initial outbreak of the pandemic changed the supply of formal and informal care to older adults in European countries and Israel and assesses the resilience of these countries in providing support to their older populations by means of a mix of both types of care. We subjected data from the Survey of Health, Ageing and Retirement in Europe COVID-19 period (SHARE-COVID-19) across 23 European countries (including Israel) to descriptive and cluster analyses. In the first wave of the outbreak, a significant proportion of older adults in European countries received informal help, with an increase in the frequency of informal help received from children, neighbors, friends, or colleagues and a decrease in that received from other relatives. In most countries, difficulties in receiving home care services from professional providers were reported. Seven clusters were identified, reflecting different combinations of changes in the formal/informal care provision. In most countries, informal care is more resilient than home care services that formal providers deliver. Since they are an essential source for sustainable care, their challenges related to care should be addressed. The impact of the pandemic does not follow the traditional characterization of welfare regimes. A clustering effort may yield more understanding of the priorities that future care policies should exhibit at the national level and may identify potential systems for policymakers to enhance sustainability of care for community-dwelling older adults.

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Interrupted time series design to evaluate ICD-9-CM to ICD-10-CM coding changes on trends in Colorado emergency department visits related to traumatic brain injury

Injury Epidemiology ◽

10.1186/s40621-021-00308-y ◽

2021 ◽

Vol 8 (1) ◽

Author(s):

Lauren Alexis De Crescenzo ◽

Barbara Alison Gabella ◽

Jewell Johnson

Keyword(s):

Public Health ◽

Traumatic Brain Injury ◽

Emergency Department ◽

Brain Injury ◽

Interrupted Time Series ◽

Emergency Department Visits ◽

Control And Prevention ◽

Icd 10 ◽

Ed Visits ◽

The Impact

Abstract Background The transition in 2015 to the Tenth Revision of the International Classification of Disease, Clinical Modification (ICD-10-CM) in the US led the Centers for Disease Control and Prevention (CDC) to propose a surveillance definition of traumatic brain injury (TBI) utilizing ICD-10-CM codes. The CDC’s proposed surveillance definition excludes “unspecified injury of the head,” previously included in the ICD-9-CM TBI surveillance definition. The study purpose was to evaluate the impact of the TBI surveillance definition change on monthly rates of TBI-related emergency department (ED) visits in Colorado from 2012 to 2017. Results The monthly rate of TBI-related ED visits was 55.6 visits per 100,000 persons in January 2012. This rate in the transition month to ICD-10-CM (October 2015) decreased by 41 visits per 100,000 persons (p-value < 0.0001), compared to September 2015, and remained low through December 2017, due to the exclusion of “unspecified injury of head” (ICD-10-CM code S09.90) in the proposed TBI definition. The average increase in the rate was 0.33 visits per month (p < 0.01) prior to October 2015, and 0.04 visits after. When S09.90 was included in the model, the monthly TBI rate in Colorado remained smooth from ICD-9-CM to ICD-10-CM and the transition was no longer significant (p = 0.97). Conclusion The reduction in the monthly TBI-related ED visit rate resulted from the CDC TBI surveillance definition excluding unspecified head injury, not necessarily the coding transition itself. Public health practitioners should be aware that the definition change could lead to a drastic reduction in the magnitude and trend of TBI-related ED visits, which could affect decisions regarding the allocation of TBI resources. This study highlights a challenge in creating a standardized set of TBI ICD-10-CM codes for public health surveillance that provides comparable yet clinically relevant estimates that span the ICD transition.

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The impact of crime on home care services.

American Journal of Public Health ◽

10.2105/ajph.77.2.209 ◽

1987 ◽

Vol 77 (2) ◽

pp. 209-210 ◽

Cited By ~ 6

Author(s):

D A Snow ◽

L S Kleinman

Keyword(s):

Home Care ◽

Home Care Services ◽

Care Services ◽

The Impact

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The Impact of Language on Emergency Department Visits, Hospitalizations, and Length of Stay Among Home Care Recipients

Medical Care ◽

10.1097/mlr.0000000000001638 ◽

2021 ◽

Vol Publish Ahead of Print ◽

Author(s):

Michael Reaume ◽

Ricardo Batista ◽

Emily Rhodes ◽

Braden Knight ◽

Haris Imsirovic ◽

...

Keyword(s):

Emergency Department ◽

Length Of Stay ◽

Home Care ◽

Emergency Department Visits ◽

Care Recipients ◽

The Impact

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Effects of Hurricanes on Emergency Department Utilization: An Analysis Across 7 US Storms

Disaster Medicine and Public Health Preparedness ◽

10.1017/dmp.2020.281 ◽

2020 ◽

pp. 1-8

Author(s):

Kevin C Heslin ◽

Marguerite L Barrett ◽

Molly Hensche ◽

Gary Pickens ◽

Jeanne S Ringel ◽

...

Keyword(s):

Emergency Department ◽

Emergency Preparedness ◽

Emergency Department Utilization ◽

Disease Category ◽

Preparedness Planning ◽

Emergency Managers ◽

Planning Processes ◽

Ed Visits ◽

The Impact ◽

Population Rate

ABSTRACT Objective: Emergency departments (EDs) are critical sources of care after natural disasters such as hurricanes. Understanding the impact on ED utilization by subpopulation and proximity to the hurricane’s path can inform emergency preparedness planning. This study examines changes in ED utilization for residents of 344 counties after the occurrence of 7 US hurricanes between 2005 and 2016. Methods: This retrospective observational study used ED data from the Healthcare Cost and Utilization Project State Inpatient Databases and State Emergency Department Databases. ED utilization rates for weeks during and after hurricanes were compared with pre-hurricane rates, stratified by the proximity of the patient county to the hurricane path, age, and disease category. Results: The overall population rate of weekly ED visits changed little post-hurricane, but rates by disease categories and age demonstrated varying results. Utilization rates for respiratory disorders exhibited the largest post-hurricane increase, particularly 2–3 weeks following the hurricane. The change in population rates by disease categories and age tended to be larger for people residing in counties closer to the hurricane path. Conclusions: Changes in ED utilization following hurricanes depend on disease categories, age, and proximity to the hurricane path. Emergency managers could incorporate these factors into their planning processes.

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Predictors and trajectories of ED visits among patients receiving palliative home care services: findings from a time series analysis (2013-2017)

BMC Palliative Care ◽

10.1186/s12904-020-00626-w ◽

2020 ◽

Vol 19 (1) ◽

Author(s):

Alberto Borraccino ◽

Sara Campagna ◽

Gianfranco Politano ◽

Marco Dalmasso ◽

Valerio Dimonte ◽

...

Keyword(s):

Time Series ◽

Time Series Analysis ◽

Home Care ◽

Home Care Services ◽

Palliative Home Care ◽

Series Analysis ◽

Care Services ◽

Ed Visits

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The Impact of Urinary Incontinence on Quality of Life in Those Receiving Home Care Services

Home Health Care Management & Practice ◽

10.1177/1084822318795439 ◽

2018 ◽

Vol 31 (1) ◽

pp. 30-34

Author(s):

Mahcube Cubukcu

Keyword(s):

Quality Of Life ◽

Urinary Incontinence ◽

Home Care ◽

Chronic Diseases ◽

Short Form ◽

Home Care Services ◽

Care Services ◽

The Mean ◽

The Impact

This study aims to evaluate the impact of urinary incontinence on the quality of life in those receiving home care services and the factors that influence this. This cross-descriptive study was performed in 180 patients who were served from Home Care Services between 01 and 28 February 2018. An International Consultation on Incontinence Questionnaire–Short Form (ICIQ-SF) was implemented in person to those who gave their informed consent with orientation and cooperation. The mean age of a 180 patients was 74.40 ± 7.80 years (min = 18, max = 104), of which 55.2% were women. The mean ICIQ-SF score was found to be 12.42 ± 4.83 (min = 0, max = 21). The lowest points were given as responses to the question, “In your opinion, what amount of leakage do you experience?” The highest points, however, were given to the question of “How much does urinary leakage interfere with your everyday life?” It was seen that when quality of life is assessed with a visual analog scale within the ICIQ-SF, the quality of life for 66.6% of elderly individuals was affected moderately or significantly. The mean ICIQ-SF scores were higher in those with chronic diseases ( p < .005). Urinary Incontinence negatively affects quality of life to a moderate and significant degree in those receiving home care. The quality of life for those who have chronic diseases was worse. In this respect, there is a need to support patients in those receiving home care services.

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The impact of social care expenditure at the end of life: a novel linkage study in Scotland

International Journal for Population Data Science ◽

10.23889/ijpds.v1i1.95 ◽

2017 ◽

Vol 1 (1) ◽

Author(s):

Claudia Geue ◽

Olivia Wu ◽

Terry J Quinn ◽

Alastair Leyland ◽

Jim Lewsey

Keyword(s):

Home Care ◽

End Of Life ◽

Inpatient Care ◽

Social Care ◽

Home Care Services ◽

Population Ageing ◽

Service Utilisation ◽

Care Services ◽

Utilisation Data ◽

The Impact

ABSTRACTBackgroundAnalyses of inpatient care admissions have shown that population ageing does not lead to an increase in future healthcare expenditure to the extent that might be expected and that remaining time to death (TTD) is an equally important cost element. But as people live longer and the onset of disease and death are postponed to older ages the utilisation of social care services is another major cost component for elderly people, in particular those with chronic diseases. However, there is a distinct lack of social care data in Scotland to estimate the impact of population ageing and TTD on social care expenditure. ObjectivesThis study aims to estimate the utilisation and associated costs of inpatient and home care services among end-of-life patients. It will also determine the feasibility of undertaking the linkage of home care service utilisation data, inpatient care episodes and death records. MethodsNHS Greater Glasgow and Clyde (NHSGGC) social home care data (Cordia), Scottish Morbidity Records (SMR01) and death records (National Records for Scotland, NRS) will be utilised in order to estimate utilisation and costs for home care services and inpatient care at the end of life. The ‘Cordia’ data is available for the period September 2013 to November 2013 and includes information on the type, duration and frequency of home care services utilised. Costs will be assigned using ‘Personal Social Services Research Unit’ (PSSRU) costs. Using multilevel modelling techniques the association between TTD, age, demographic and socio-economic measures and expenditure on home care services will be estimated, while allowing the effect of covariates to vary over hierarchical levels, such as episode of care and the patient. Expected OutcomesThe wider literature suggests that contrary to inpatient care, costs at the end of life for the oldest old might be higher when considering elements of social care provision. The ‘Cordia’ data consists of 7,367 individuals with 1,620 observed deaths. Further results are forthcoming and findings will significantly add to the knowledge base in the area of population ageing and related health- and social care expenditure. This is a novel linkage and given the difficulties in obtaining social care data, this study will i) help to evaluate the feasibility of using these data for research, and ii) identify where costs at the end of life occur, thus facilitating more targeted approaches to end-of-life care.

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The impact of COVID-19 on hospital admissions and emergency department visits: A population-based study

PLoS ONE ◽

10.1371/journal.pone.0252441 ◽

2021 ◽

Vol 16 (6) ◽

pp. e0252441

Author(s):

Elissa Rennert-May ◽

Jenine Leal ◽

Nguyen Xuan Thanh ◽

Eddy Lang ◽

Shawn Dowling ◽

...

Keyword(s):

Public Health ◽

Emergency Department ◽

Hospital Admissions ◽

Population Based ◽

Emergency Department Visits ◽

System Capacity ◽

Population Based Study ◽

Health Measures ◽

Ed Visits ◽

The Impact

Background As a result of the novel coronavirus disease 2019 (COVID-19), there have been widespread changes in healthcare access. We conducted a retrospective population-based study in Alberta, Canada (population 4.4 million), where there have been approximately 1550 hospital admissions for COVID-19, to determine the impact of COVID-19 on hospital admissions and emergency department (ED visits), following initiation of a public health emergency act on March 15, 2020. Methods We used multivariable negative binomial regression models to compare daily numbers of medical/surgical hospital admissions via the ED between March 16-September 23, 2019 (pre COVID-19) and March 16-September 23, 2020 (post COVID-19 public health measures). We compared the most frequent diagnoses for hospital admissions pre/post COVID-19 public health measures. A similar analysis was completed for numbers of daily ED visits for any reason with a particular focus on ambulatory care sensitive conditions (ACSC). Findings There was a significant reduction in both daily medical (incident rate ratio (IRR) 0.86, p<0.001) and surgical (IRR 0.82, p<0.001) admissions through the ED in Alberta post COVID-19 public health measures. There was a significant decline in daily ED visits (IRR 0.65, p<0.001) including ACSC (IRR 0.75, p<0.001). The most common medical/surgical diagnoses for hospital admissions did not vary substantially pre and post COVID-19 public health measures, though there was a significant reduction in admissions for chronic obstructive pulmonary disease and a significant increase in admissions for mental and behavioral disorders due to use of alcohol. Conclusions Despite a relatively low volume of COVID-19 hospital admissions in Alberta, there was an extensive impact on our healthcare system with fewer admissions to hospital and ED visits. This work generates hypotheses around causes for reduced hospital admissions and ED visits which warrant further investigation. As most publicly funded health systems struggle with health-system capacity routinely, understanding how these reductions can be safely sustained will be critical.

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Can Home Palliative Care services reduce Emergency Department visits? Piedmont Experience, 2013-2018

European Journal of Public Health ◽

10.1093/eurpub/ckaa165.1009 ◽

2020 ◽

Vol 30 (Supplement_5) ◽

Author(s):

A Scacchi ◽

P Berchialla ◽

M Dalmasso ◽

M M Gianino

Keyword(s):

Emergency Department ◽

Palliative Care ◽

Medical Care ◽

Care Delivery ◽

Emergency Department Visits ◽

Care Services ◽

Medical Care Costs ◽

Home Based ◽

Ed Visits ◽

Care Costs

Abstract Background Home-based Palliative Care (HPC) ensures multi-disciplinary medical, nursing, rehabilitation and psychological assistance for people with severe disabilities or with progressive end-stage disorders like cancer, promoting the continuity of care in home setting. Emergency Department (ED) visits in palliative care patients are considered an indicator of poor quality in home care services, since ED visits in these patients are not essential and potentially avoidable. There is still no agreement in literature about the efficacy of HPC in reducing the use of ED. However, recent studies demonstrated that HPC increases patient satisfaction while reducing use of medical services like ED, symptom burden and medical costs. The objective of this study was to evaluate if patients assisted by HPC have a reduction of ED visits compared to the 90-day period before HPC admission. Methods A retrospective study using the administrative regional database of Piedmont (Italy) was conducted on the cohort of 4433 patients admitted to HPC from 2013 to 2018. ED visits during period A (90-days before HPC) and period B (during HPC) were compared for each patient, taking into account avoidable or unavoidable visits based on triage examination. Results During period A, patients had 2880 ED visits, 1934 were considered avoidable (67%). During period B, 2050 ED visits were recorded, 994 were considered avoidable (48%). Patients receiving HPC had a reduction of overall ED visits (IRR 0.87, IC 95% 0.82-0.92) as well as avoidable ED visits (IRR 0.63, IC 95% 0.58-0.67). Unavoidable ED visits increased during HPC (IRR 1.36, IC 95% 1.24-1.49), as a consequence of disease progression. Conclusions Home-based Palliative Care is associated with a significant reduction of the use of overall Emergency Department visits (-13%) and ED avoidable visits (-37%). Since it reduces medical care costs and burden of patients and caregivers at the end of life, Home-based Palliative Care delivery should be increased. Key messages Home-based Palliative Care is associated with a reduction of the use of overall Emergency Department visits and avoidable ED visits, reducing medical care costs and burden of patients and caregivers. Home-based Palliative Care delivery should be encouraged and increased, aiming to an early enrolment as well as an increase of the patients.

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