Substudy 14 Fact Sheet

Evaluation of the Cost-Effectiveness of the Quick Response Program of Saskatoon District Health (NA101-14)

Sponsor Organization:
Saskatoon District Health

Rationale/Goals:
This project is one of fifteen sub-studies of the National Evaluation of the Cost-Effectiveness of Home Care Project (NA101). People who come to hospital emergency departments with non-acute conditions may be admitted to hospital because there are no appropriate community-based alternatives, or because they are either unaware of these alternatives, or unable to access them. To fill this gap, Quick Response Programs (QRPs) are intended to divert such people from hospitals to suitable community-based care. Typically, QRPs can assess patients rapidly - usually within two hours - and then refer them to other services. This evaluation project sought to determine whether Saskatoon District Health's QRP has been successful in decreasing hospital admissions for elderly non-acute patients, and whether the program is cost-effective.

Activities:
Quick Response Programs (QRPs) provide access for individuals to an alternate care option that involves an interdisciplinary and multi-sectoral approach to problem-solving, decision-making, and delivery of appropriate community-based care from a variety of sources. Within Saskatoon District Health (SDH), the QRP is modeled within a well-established, single-entry, case management framework for community-based services, the Coordinated Assessment Unit (CAU). QRPs arrange for additional care in the home as an alternative for individuals who would normally be admitted to the hospital upon presentation at the Emergency Departments (EDs) in Saskatoon.

Key Findings:
The project leaders identified the following outcomes:

• Patients who accepted QRP services and then returned home received a greater range and intensity of community-based services.
  
• The average total cost of community-based services for QRP patients for 30 days was $358.
  
• Of 521 patients admitted to hospital as in-patients, only two were subsequently determined to have been non-acute (i.e., comparable to QRT clients). The total non-acute hospital care costs for the total hospital stay for these individuals was $3,927.
  
• Forty-six patients were identified as multiple users of emergency department services, with between four and 19 visits in the 11-week period. Sixty-three per cent of those visits were found to have been preventable, though not necessarily by services QRP could have initiated.

Implications:
The project leaders indicated that their findings are important because, in their view, this study suggests that Saskatoon District Health's QRP can successfully identify non-acute patients, and secure access to appropriate community-based care for them. However, although such services are considerably cheaper than hospital-based care, this process will not decrease overall expenditures unless corresponding numbers of hospital beds are eventually closed.

Evaluation Methodology:
The evaluation reviewed the charts of 2,343 elderly people who made a total of 3,074 visits to the emergency departments of three Saskatoon hospitals between September 27 and December 11, 1999. The level of acuity for those who were admitted as in-patients was assessed using a standard tool (InterQual® ISD-A). For those not admitted, data were collected on community-based services provided to patients for 30 days before and after the visit to emergency. For all the community-based services accessed through the QRP, the cost of providing direct and indirect patient care was calculated (including travel time). These costs were compared to the in-patient costs of caring for patients who were admitted to the hospital, but who could have been cared for by a community-based service.

Resources Developed:

HTF Contribution to the Project:
$1,505,000 (divided among the 15 sub-studies)

Language of Report:
English

• Executive summary
• Full report