Department of Emergency Medicine, Yale University, New Haven, Connecticut.
Geriatric Research, Education Clinical Center, James J. Peters Veterans Affairs Medical Center, Bronx, New York.
JAMA Netw Open. 2021 Mar 1;4(3):e2037334. doi: 10.1001/jamanetworkopen.2020.37334.
There has been a significant increase in the implementation and dissemination of geriatric emergency department (GED) programs. Understanding the costs associated with patient care would yield insight into the direct financial value for patients, hospitals, health systems, and payers.
To evaluate the association of GED programs with Medicare costs per beneficiary.
DESIGN, SETTING, AND PARTICIPANTS: This cross-sectional study included data on Medicare fee-for-service beneficiaries at 2 hospitals implementing Geriatric Emergency Department Innovations in Care Through Workforce, Informatics, and Structural Enhancement (GEDI WISE) (Mount Sinai Medical Center [MSMC] and Northwestern Memorial Hospital [NMH]) from January 1, 2013, to November 30, 2016. Analyses were conducted and refined from August 28, 2018, to November 20, 2020, using entropy balance to account for observed differences between the treatment and comparison groups.
Treatment included consultation with a transitional care nurse (TCN) or a social worker (SW) trained for the GEDI WISE program at a beneficiary's first ED visit (index ED visit). The comparison group included beneficiaries who were never seen by either a TCN or an SW during the study period.
The main outcome evaluated was prorated total Medicare payer expenditures per beneficiary over 30 and 60 days after the index ED visit encounter.
Of the total 24 839 unique Medicare beneficiaries, 4041 were seen across the 2 EDs; 1947 (17.4%) at MSMC and 2094 (15.4%) at the NMH received treatment from either a GED TCN and/or a GED SW. The mean (SD) age of beneficiaries at MSMC was 78.8 (8.5) years and at NMH was 76.4 (7.7) years. Most patients at both hospitals were female (6821 [60.8%] at MSMC and 8023 [58.9%] at NMH) and White (7729 [68.9%] at MSMC and 9984 [73.3%] at NMH). Treatment was associated with statistically significant mean savings per beneficiary of $2436 (95% CI, $1760-$3111; P < .001) at one ED and $2905 (95% CI, $2378-$3431; P < .001) at the other ED in the 30 days after the index ED visit. The association between treatment and mean cumulative savings at 60 days after the index ED visit per beneficiary was also significant: $1200 (95% CI, $231-$2169; P = .02) at one ED and $3202 (95% CI, $2452-$3951; P < .001) at the other ED.
Among Medicare fee-for-service beneficiaries, receipt of ED-based geriatric treatment by a TCN and/or an SW was associated with lower Medicare expenditures. These estimated cost savings may be used when calculating or considering the bundled value and potential reimbursement per patient for GED care programs.
老年急诊部 (GED) 项目的实施和传播显著增加。了解与患者护理相关的成本将深入了解患者、医院、医疗系统和支付方的直接财务价值。
评估 GED 项目与每位 Medicare 受益人的成本之间的关联。
设计、设置和参与者：这项横断面研究纳入了 2013 年 1 月 1 日至 2016 年 11 月 30 日期间在实施通过劳动力、信息学和结构增强进行老年急诊部创新 (GEDI WISE) 的两家医院（西奈山医疗中心 [MSMC] 和西北纪念医院 [NMH]）的 Medicare 收费服务受益人的数据。分析于 2018 年 8 月 28 日至 2020 年 11 月 20 日进行和细化，使用熵平衡来解释治疗组和对照组之间观察到的差异。
治疗包括在受益人首次急诊就诊时（索引急诊就诊）咨询经过 GEDI WISE 项目培训的过渡护理护士 (TCN) 或社会工作者 (SW)。对照组包括在研究期间从未接受过 TCN 或 SW 服务的受益人。
主要评估结果是索引急诊就诊后 30 天和 60 天内每位受益人的按比例 Medicare 总支付额。
在 24839 名独特的 Medicare 受益人中，有 4041 名在两家急诊就诊；1947 名（17.4%）在 MSMC 和 2094 名（15.4%）在 NMH 接受了 GED TCN 和/或 GED SW 的治疗。MSMC 的受益人的平均（SD）年龄为 78.8（8.5）岁，而 NMH 的受益人的平均（SD）年龄为 76.4（7.7）岁。两家医院的大多数患者都是女性（MSMC 为 6821 [60.8%]，NMH 为 8023 [58.9%]）和白人（MSMC 为 7729 [68.9%]，NMH 为 9984 [73.3%]）。治疗与在索引急诊就诊后 30 天内每位受益人的节省额具有统计学意义，在一家急诊就诊时为 2436 美元（95%CI，1760-3111；P<0.001），在另一家急诊就诊时为 2905 美元（95%CI，2378-3431；P<0.001）。在索引急诊就诊后 60 天内治疗与每位受益人的累计节省之间的关联也具有统计学意义：一家急诊就诊时为 1200 美元（95%CI，231-2169；P=0.02），另一家急诊就诊时为 3202 美元（95%CI，2452-3951；P<0.001）。
在 Medicare 收费服务受益人中，TCN 和/或 SW 提供的基于急诊的老年治疗与 Medicare 支出较低相关。这些估计的成本节约可用于计算或考虑 GED 护理项目的捆绑价值和每位患者的潜在报销额。
