Dataset Information

Economic evaluation of the differential benefits of home visits with telephone calls and telephone calls only in transitional discharge support.

ABSTRACT:

Background

home visits and telephone calls are two often used approaches in transitional care, but their differential economic effects are unknown.

Objective

to examine the differential economic benefits of home visits with telephone calls and telephone calls only in transitional discharge support.

Design

cost-effectiveness analysis conducted alongside a randomised controlled trial (RCT).

Participants

patients discharged from medical units randomly assigned to control (control, N = 210), home visits with calls (home, N = 196) and calls only (call, N = 204).

Methods

cost-effectiveness analyses were conducted from the societal perspective comparing monetary benefits and quality-adjusted life years (QALYs) gained.

Results

the home arm was less costly but less effective at 28 days and was dominating (less costly and more effective) at 84 days. The call arm was dominating at both 28 and 84 days. The incremental QALY for the home arm was -0.0002/0.0008 (28/84 days), and the call arm was 0.0022/0.0104 (28/84 days). When the three groups were compared, the call arm had a higher probability being cost-effective at 84 days but not at 28 days (home: 53%, call: 35% (28 days) versus home: 22%, call: 73% (84 days)) measuring against the NICE threshold of £20,000.

Conclusion

the original RCT showed that the bundled intervention involving home visits and calls was more effective than calls only in the reduction of hospital readmissions. This study adds a cost perspective to inform policymakers that both home visits and calls only are cost-effective for transitional care support, but calls only have a higher chance of being cost-effective for a sustained period after intervention.

SUBMITTER: Wong FK

PROVIDER: S-EPMC4255617 | biostudies-literature | 2015 Jan

REPOSITORIES: biostudies-literature

ACCESS DATA

Publications

Economic evaluation of the differential benefits of home visits with telephone calls and telephone calls only in transitional discharge support.

Wong Frances Kam Yuet FK So Ching C Chau June J Law Antony Kwan Pui AK Tam Stanley Ku Fu SK McGhee Sarah S

Age and ageing 20141029 1

<h4>Background</h4>home visits and telephone calls are two often used approaches in transitional care, but their differential economic effects are unknown.<h4>Objective</h4>to examine the differential economic benefits of home visits with telephone calls and telephone calls only in transitional discharge support.<h4>Design</h4>cost-effectiveness analysis conducted alongside a randomised controlled trial (RCT).<h4>Participants</h4>patients discharged from medical units randomly assigned to contro ...[more]

PMID: 25355620

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Project description:BackgroundPromoting safe and efficient transitions of care is critical to reducing readmission rates and associated costs and improving the quality of patient care. A growing body of literature suggests that transitional care (TC) programs are effective in improving quality of life and reducing unplanned readmissions for several patient groups. TC programs are highly complex and multidimensional, requiring evidence on how specific practices and system characteristics influence their effectiveness in patient care, readmission reduction and costs.MethodsUsing a systematic review and a configurational approach, the study examines the role played by system characteristics (size, ownership, professional skills, technology used), the organizational components implemented, analyzing their combinations, and the potential economic impact of TC programs.ResultsThe more organizational components are implemented, the greater the likelihood that a TC program will be successful in reducing readmission rates. Not all components have the same effect. The results show that certain components, 'post-discharge symptom monitoring and management' and 'discharge planning', are necessary but not sufficient to achieve the outcome. The results indicate the existence of two different combinations of components that can be considered sufficient for the reduction of readmissions. Furthermore, while system characteristics are underexplored, the study shows different ways of incorporating the skill mix of professionals and their mode of coordination in TC programs. Four organizational models emerge: the health-based monocentric, the social-based monocentric, the multidisciplinary team and the mono-specialist team. The economic impact of the programs is generally positive. Despite an increase in patient management costs, there is an overall reduction in all post-intervention costs, particularly those related to readmissions.ConclusionsThe results underline the importance of examining in depth the role of system characteristics and organizational factors in facilitating the creation of a successful TC program. The work gives preliminary insights into how to systematize organizational practices and different coordination modes for facilitating decision-makers' choices in TC implementation. While there is evidence that TC programs also have economic benefits, the quality of economic evaluations is relatively low and needs further study.

Dataset Information

Economic evaluation of the differential benefits of home visits with telephone calls and telephone calls only in transitional discharge support.

Background

Objective

Design

Participants

Methods

Results

Conclusion

Publications

Economic evaluation of the differential benefits of home visits with telephone calls and telephone calls only in transitional discharge support.

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