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Home-based intermediate care program vs hospitalization

Cost comparison study

William E. Hogg, MClSc MD FCFP
Director of the C.T. Lamont Primary Health Care Research Centre at the Élisabeth Bruyère Research Institute, a Professor in the Department of Family Medicine at the University of Ottawa, and a Principal Scientist at the Institute of Population Health in Ottawa

Jacques Lemelin, MD CM CCFP FCFP
Professor and Chair of the Department of Family Medicine at the University of Ottawa

Simone Dahrouge, MSc
Research Manager at the C.T. Lamont Primary Health Care Research Centre

Carmel Martin, PhD MRCGP FRACGP
Associate Professor of Family Medicine at the University of Ottawa and at the Northern Ontario School of Medicine in Ottawa

Gary S. Viner, MD CCFP FCFP
Associate Professor in the Department of Family Medicine at the University of Ottawa

Raphael Saginur, MD CM FRCPC FIDSA
Chief of Infectious Diseases at the Ottawa Hospital (Civic Campus) and an Associate Professor of Medicine at the University of Ottawa

Correspondence to: Dr William Hogg, C.T. Lamont Centre, Élisabeth Bruyère Research Institute, 43 Bruyère St, Ottawa, ON K1N 5C8; telephone 613 562-4262, extension 1354; e-mailwhogg{at}uottawa.ca

OBJECTIVE To explore whether a home-based intermediate care program in a large Canadian city lowers the cost of care and to look at whether such home-based programs could be a solution to the increasing demands on Canadian hospitals.

DESIGN Single-arm study with historical controls.

SETTING Department of Family Medicine at the Ottawa Hospital (Civic campus) in Ontario.

PARTICIPANTS Patients requiring hospitalization for acute care. Participants were matched with historical controls based on case-mix, most responsible diagnosis, and level of complexity.

INTERVENTIONS Placement in the home-based intermediate care program. Daily home visits from the nurse practitioner and 24-hour access to care by telephone.

MAIN OUTCOME MEASURES Multivariate regression models were used to estimate the effect of the program on 5 outcomes: length of stay in hospital, cost of care substituted for hospitalization (Canadian dollars), readmission for a related diagnosis, readmission for any diagnosis, and costs incurred by community home-care services for patients following discharge from hospital.

RESULTS The outcomes of 43 hospital admissions were matched with those of 363 controls. Patients enrolled in the program stayed longer in hospital (coefficient 3.3 days, P < .001), used more community care services following discharge (coefficient $729, P = .007), and were more likely to be readmitted to hospital within 3 months of discharge (coefficient 17%, P = .012) than patients treated in hospital. Total substituted costs of home-based care were not significantly different from the costs of hospitalization (coefficient -$501, P = .11).

CONCLUSION While estimated cost savings were not statistically significant, the limitations of our study suggest that we underestimated these savings. In particular, the economic inefficiencies of a small immature program and the inability to control for certain factors when selecting historical controls affected our results. Further research is needed to determine the economic effect of mature home-based programs.