Association between a mobile team intervention in Swedish municipal home care and the effect on emergency department visits and hospitalizations among older adults.

BACKGROUND

Elderly individuals with chronic conditions or acute illnesses are major drivers of hospitalization, with frail patients frequently utilizing emergency department (ED) services. To ease this burden, many countries offer home-based medical services. In Region Halland, Sweden, a mobile team intervention in municipal home care (MHC) was introduced to support frail elderly patients. This study aimed to assess whether the intervention reduced ED visits and hospitalizations among MHC recipients.

METHODS

The study population consisted of all patients aged ≥ 65 years enrolled in MHC in Halmstad, Sweden, from October 2014 - April 2016. Healthcare utilization during the seven months prior to the initiation of the intervention (October 2014 - April 2015) constituted the pre-intervention group and were compared with healthcare consumption during a seasonally matched seven-month period after the launch of the intervention (October 2015-April 2016). The primary outcome was the number of adverse events, defined as unplanned ED visits or hospital admission. Negative binomial regression was used to assess the association between exposure and adverse events, presented as Incidence Rate Ratios (IRRs) with 95% confidence intervals (CIs).

RESULTS

A total of 2163 patients were included in the pre-intervention group, and 2197 patients in the intervention group. Both groups had a mean age of 84 years, with no significant differences regarding sex. In the pre-intervention group, 64% had severe comorbidities, compared to 66% in the intervention group. Primary care home visits by physicians increased from an average of 0.9 in the pre-intervention group to 1.1 in the intervention group (p < 0.001). Risk for adverse events was elevated among patients with severe comorbidities (IRR = 3.14, 95% CI: 1.91-5.15, p = < 0.001). There was a slight decrease in the incidence rate for the intervention group; however, this reduction was not statistically significant (IRR = 0.91, 95% CI: 0.82-1.01, p = 0.09).

CONCLUSION

The mobile team intervention in MHC did not significantly reduce ED visits or hospitalizations among elderly MHC recipients, suggesting that physician-led interventions alone may be insufficient to lower acute care utilization in this population. This highlights the complexity of care needs among frail older adults and suggests that a more comprehensive, multidisciplinary approach may be required to achieve meaningful reductions in emergency care use.