Emergency department admissions and economic costs burden related to ambulatory care sensitive conditions in older adults living in care homes

Afonso-Argilés, Francisco Javier; Comas Serrano, Mercè; Castells Oliveres, Xavier; Cirera Lorenzo, Isabel; García Pérez, Dolors; Pujadas Lafarga, Teresa; Ichart Tomás, Xavier; Puig-Campmany, Mireia; Vena Martínez, Ana B.; Renom-Guiteras, Anna; Caregency Group

doi:http://dx.doi.org/10.1016/j.rceng.2023.10.001

Emergency department admissions and economic costs burden related to ambulatory care sensitive conditions in older adults living in care homes

Citation

Javier Afonso-Argilés F, Comas Serrano M, Castells Oliveres X, Cirera Lorenzo I, García Pérez D, Pujadas Lafarga T, et al. Emergency department admissions and economic costs burden related to ambulatory care sensitive conditions in older adults living in care homes. Rev Clin Esp (Barc). 2023 Dec;223(10):585-95. DOI: 10.1016/j.rceng.2023.10.001

Abstract

Objectives: To assess the frequency of emergency department admissions (EDA) for ambulatory care sensitive conditions (ACSC) and non-ACSC among older adults living in care homes (CH), to describe and compare their demographic and clinical characteristics, the outcomes of the hospitalisation process and the associated costs. Method: This multicenter, retrospective and observational study evaluated 2444 EDAs of older adults ≥ 65 years old living in care homes in 5 emergency departments in Catalonia (Spain) by ACSC and non-ACSC, in 2017. Sociodemographic variables, prior functional and cognitive status, and information on diagnosis and hospitalisation were collected. Additionally, the costs related with the EDAs were calculated, as well as a sensitivity analysis using different assumptions of decreased admissions due to ACSC. Results: A total of 2444 ED admissions were analysed. The patients' mean (SD) age was 85.9 (7.2) years. The frequency of ACSC-EDA and non-ACSC-EDA was 56.6% and 43.4%, respectively. Severe dependency and cognitive impairment were present in 56.6% and 78%, respectively, with no differences between the two groups. The three most frequent ACSC were falls/trauma (13.8%), chronic obstructive pulmonary disease/asthma (11.4%) and urinary tract infection (7.4%). The average cost per ACSC-EDA was є1,408.24. Assuming a 60% reduction of ACSC-EDA, the estimated cost savings would be є1.2 million. Conclusions: Emergency admissions for ACSC from care homes have a significant impact on both frequency and costs. Reducing these conditions through targeted interventions could redirect the avoided costs towards improving care support in residential settings.