Healthcare pathways and resource use : mapping consequences of ambulance assessment for direct care with alternative healthcare providers

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Varg , S , Vicente , V , Castren , M , Lindgren , P & Rehnberg , C 2020 , ' Healthcare pathways and resource use : mapping consequences of ambulance assessment for direct care with alternative healthcare providers ' , BMC Emergency Medicine , vol. 20 , no. 1 , 85 . https://doi.org/10.1186/s12873-020-00380-5

Title: Healthcare pathways and resource use : mapping consequences of ambulance assessment for direct care with alternative healthcare providers
Author: Varg, Sofi; Vicente, Veronica; Castren, Maaret; Lindgren, Peter; Rehnberg, Clas
Contributor organization: HUS Emergency Medicine and Services
Department of Diagnostics and Therapeutics
Helsinki University Hospital Area
Date: 2020-10-30
Language: eng
Number of pages: 8
Belongs to series: BMC Emergency Medicine
ISSN: 1471-227X
DOI: https://doi.org/10.1186/s12873-020-00380-5
URI: http://hdl.handle.net/10138/322265
Abstract: Background A decision system in the ambulance allowing alternative pathways to alternate healthcare providers has been developed for older patients in Stockholm, Sweden. However, subsequent healthcare resource use resulting from these pathways has not yet been addressed. The aim of this study was therefore to describe patient pathways, healthcare utilisation and costs following ambulance transportation to alternative healthcare providers. Methods The design of this study was descriptive and observational. Data from a previous RCT, where a decision system in the ambulance enabled alternative healthcare pathways to alternate healthcare providers were linked to register data. The receiving providers were: primary acute care centre or secondary geriatric ward, both located at the same community hospital, or the conventional pathway to the emergency department at an acute hospital. Resource use over 10 days, subsequent to assessment with the decision system, was mapped in terms of healthcare pathways, utilisation and costs for the 98 included cases. Results Almost 90% were transported to the acute care centre or geriatric ward. The vast majority arriving to the geriatric ward stayed there until the end of follow-up or until discharged, whereas patients conveyed to the acute care centre to a large extent were admitted to hospital. The median patient had 6 hospital days, 2 outpatient visits and costed roughly 4000 euros over the 10-day period. Arrival destination geriatric ward indicated the longest hospital stay and the emergency department the shortest. However, the cost for the 10-day period was lower for cases arriving to the geriatric ward than for those arriving to the emergency department. Conclusions The findings support the appropriateness of admittance directly to secondary geriatric care for older adults. However, patients conveyed to the acute care centre ought to be studied in more detail with regards to appropriate level of care.
Subject: Emergency medical services
Health care costs
Aged
Decision support systems
clinical
Critical pathways
Delivery of health care
OLDER-PEOPLE
PREHOSPITAL CARE
COST-EFFECTIVENESS
EMERGENCY
SUPPORT
ORGANIZATION
MORTALITY
URGENT
SYSTEM
ADULTS
3126 Surgery, anesthesiology, intensive care, radiology
Peer reviewed: Yes
Rights: cc_by
Usage restriction: openAccess
Self-archived version: publishedVersion


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