Perttu Kontunen, Roope Leppänen, Miika Linna, Maaret Castrén, Paulus Torkki
Department of Public Health, University of Helsinki, Helsinki, Uusimaa, Finland.
Hospital Services, Western Uusimaa County Wellbeing Services, Espoo, Uusimaa, Finland.
Age Ageing. 2025 Jan 6;54(1). doi: 10.1093/ageing/afae287.
The global trend of emergency department (ED) crowding can be mitigated with outreach care. The Mobile Hospital is an outreach acute care service in Espoo, Finland. This study describes the results of the Mobile Hospital intervention to nursing homes in a pre-post study setting with benchmarking validation data.
We compared Emergency Medical Services (EMS) missions, ED visits, hospitalisations and their estimated costs from two 6-month periods in 2018-2019 (1325 nursing home beds). Benchmarking control data for ED visits were obtained from health records of the 10 largest Finnish cities.
The number of EMS missions to nursing homes decreased by 16% (720 vs 604), ED visits decreased by 22% (801 vs 622), there was no significant difference in specialised inpatient episodes (178 vs 162) and primary hospital inpatient episodes were fewer (285 vs 178, decreased 38%). Annual estimated savings per resident were 686 euros (decreased 14%). Annual estimated total savings were 934 908 euros. In the benchmarking analysis, the number of ED visits and acute hospitalisations amongst the older population decreased in Espoo, while in the other cities it increased.
The Mobile Hospital seems to reduce nursing home residents' ED visits, hospitalisations and overall costs. Advance care planning and on-call physician telephone consultations may be useful components of the service.Implications to practice: This study adds to the growing evidence that outreach care to nursing homes is cost-effective in suburban areas with universal healthcare funding, at least as part of other developments in the acute care pathway.
可通过外展护理缓解急诊科拥挤的全球趋势。移动医院是芬兰埃斯波的一项外展急性护理服务。本研究在一项前后对照研究中描述了移动医院对养老院干预的结果，并带有基准验证数据。
我们比较了2018 - 2019年两个6个月期间（1325张养老院床位）的紧急医疗服务（EMS）任务、急诊科就诊、住院情况及其估计成本。急诊科就诊的基准对照数据来自芬兰10个最大城市的健康记录。
前往养老院的EMS任务数量减少了16%（720次对604次），急诊科就诊减少了22%（801次对622次），专科住院病例无显著差异（178例对162例），一级医院住院病例减少（285例对178例，减少38%）。每位居民的年度估计节省费用为686欧元（减少14%）。年度估计总节省费用为934908欧元。在基准分析中，埃斯波老年人口的急诊科就诊和急性住院人数减少，而其他城市则增加。
移动医院似乎减少了养老院居民的急诊科就诊、住院次数和总体费用。预先护理计划和随叫随到医生电话咨询可能是该服务的有用组成部分。对实践的启示：本研究进一步证明，在全民医疗保健资金支持的郊区，对养老院的外展护理具有成本效益，至少作为急性护理途径中其他发展的一部分。
