Present address: Department of Medical Information (DIM), Toulouse University Hospital, 2 rue Viguerie, Toulouse Cedex 9, 31059, France.
INSERM, UMR 1295, Toulouse, France.
BMC Geriatr. 2024 Apr 19;24(1):353. doi: 10.1186/s12877-024-04946-x.
Transfers of nursing home (NH) residents to the emergency department (ED) is frequent. Our main objective was to assess the cost of care pathways 6 months before and after the transfer to the emergency department among NH residents, according to the type of transfer (i.e. appropriate or inappropriate).
This was a part of an observational, multicenter, case-control study: the Factors associated with INappropriate transfer to the Emergency department among nursing home residents (FINE) study. Sixteen public hospitals of the former Midi-Pyrénées region participated in recruitment, in 2016. During the inclusion period, all NH residents arriving at the ED were included. A pluri-disciplinary team categorized each transfer to the ED into 2 groups: appropriate or inappropriate. Direct medical and nonmedical costs were assessed from the French Health Insurance (FHI) perspective. Healthcare resources were retrospectively gathered from the FHI database and valued using the tariffs reimbursed by the FHI. Costs were recorded over a 6-month period before and after transfer to the ED. Other variables were used for analysis: sex, age, Charlson score, season, death and presence inside the NH of a coordinating physician or a geriatric nursing assistant.
Among the 1037 patients initially included in the FINE study, 616 who were listed in the FHI database were included in this economic study. Among them, 132 (21.4%) had an inappropriate transfer to the ED. In the 6 months before ED transfer, total direct costs on average amounted to 8,145€ vs. 6,493€ in the inappropriate and appropriate transfer groups, respectively. In the 6 months after ED transfer, they amounted on average to 9,050€ vs. 12,094€.
Total costs on average are higher after transfer to the ED, but there is no significant increase in healthcare expenditure with inappropriate ED transfer. Support for NH staff and better pathways of care could be necessary to reduce healthcare expenditures in NH residents.
clinicaltrials.gov, NCT02677272.
养老院（NH）居民向急诊科（ED）转移的情况很常见。我们的主要目的是根据转移类型（即适当或不适当）评估 NH 居民转移到 ED 前后 6 个月的护理路径成本。
这是一项观察性、多中心、病例对照研究的一部分：与养老院居民不适当转移到急诊科相关的因素（FINE）研究。前米迪-比利牛斯地区的 16 家公立医院参与了招募，时间是在 2016 年。在纳入期间，所有到达 ED 的 NH 居民都被纳入研究。一个多学科小组将每个转移到 ED 的病例分为两组：适当或不适当。从法国医疗保险（FHI）的角度评估直接医疗和非医疗费用。医疗资源从 FHI 数据库中回顾性收集，并根据 FHI 报销的费率进行估值。费用在转移到 ED 前后的 6 个月内记录。还使用了其他变量进行分析：性别、年龄、Charlson 评分、季节、死亡以及 NH 内是否有协调医生或老年护理助理。
在最初纳入 FINE 研究的 1037 名患者中，有 616 名患者被列入 FHI 数据库，纳入了这项经济研究。其中，132 名（21.4%）患者的 ED 转移不适当。在 ED 转移前的 6 个月内，平均直接总成本为 8145 欧元，而不适当和适当转移组分别为 6493 欧元。在 ED 转移后的 6 个月内，平均总成本分别为 9050 欧元和 12094 欧元。
平均而言，转移到 ED 后总成本更高，但 ED 转移不适当并没有导致医疗支出显著增加。可能需要为 NH 工作人员提供支持并改善护理路径，以减少 NH 居民的医疗支出。
clinicaltrials.gov，NCT02677272。
