Substudy 14 Executive Summary

Substudy 14: Evaluation of the Cost-Effectiveness of the Quick Response Team Program of Saskatoon District Health

by Cordell Neudorf and Joanne Franko

Providing effective health care that is accessible and appropriate is the goal of any health care system. Finding alternate delivery systems that are cost-effective or cost-comparable has become increasingly important with rising health care costs.

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).

The overall goal of this study was to determine if the QRP of the CAU in SDH is a cost-effective or lower cost alternative for providing care to individuals who instead would have been admitted to hospital upon presentation at the Emergency Departments (EDs) in Saskatoon.

This study was a retrospective chart review of individuals age 60 and over, who live in SDH in their own home or a private/personal care home who accessed an ED in SDH between September 26 and December 11, 1999. Data on the time spent in providing community-based services were collected for 30 days before and 30 days after the ED visit. Community-based services include: Home Care - Nursing and Home Services; Community Services - Physical Therapy, Occupational Therapy, Social Work; and Meals on Wheels. Data on time spent in providing services by CAU and QRP Coordinators were collected for 30 days after the ED visit. Level of acuity of the individuals admitted to hospital through the ED was assessed using the InterQual® ISD-A tool. The departments who provide community-based services provided values for the unit cost of patient care time (direct and indirect care) and travel time. This was used to calculate the costs of providing community-based services. The cost of substitutable hospital days was calculated for those individuals who could have had their care provided by an alternate level of care.

During the study period, there were 3,074 ED visits made by 2,343 individuals who met the study inclusion criteria. The mean age of this group was 75.3 years, with a range of 60 - 103 years. Each individual who visited the EDs was placed into one of three groups:

• Group 1. These were individuals who were referred to QRP, were seen by QRP, had community-based services initiated by QRP and were sent home. (n=136)
• Group 2. These were individuals who were referred to QRP, were seen by QRP, refused services and were either sent home or admitted to hospital. (n=40)
• Group 3. These were individuals who were not referred to QRP, and were sent home or admitted to hospital. It was hypothesized that a referral to QRP may have prevented the admission or subsequent repeat visits to the ED. (n=2169)

As expected, the type and intensity of community-based services was the greatest for Group 1. Every community-based service accessed by these individuals saw an increase in services and subsequently, associated costs. The increase for nursing services was, however the only statistically significant finding. The average cost of providing community-based services for 1 individual in Group 1, for a total of 30 days after the ED visit, was $358.05.

There were 521 hospital admissions from the ED that were assessed for level of acuity; 2 were found to be non-acute. The total cost for 12 days of non-acute hospital care for this group was $3,927.00.

During preliminary data analysis, another group of individuals was revealed - those individuals who repeatedly visited the EDs during the study period. It was decided to add another group for further analysis, which were those individuals who had 4 or more visits to the ED during the study period. This became Group 4, with n=46. The range of the number of repeat visits was 4 - 19, and the mean number of visits was 5.8 per individual. The ED chart records were reviewed by QRP Coordinators, in an attempt to see if any of these repeat visits were preventable. For the individuals whose ED chart records were reviewed, it was determined that 63% of these visits were preventable, but not necessarily by services QRP could have initiated.

QRP provides access to appropriate effective alternate level of care for non-acute individuals as compared to hospital care. The costs to provide community-based services initiated by QRP are cheaper than the cost of providing hospital care. However, to say that QRP decreases health care expenditures is not accurate unless hospital beds are closed when QRP is implemented.

Implementing QRP is an appropriate, client-focused method of providing access to community-based services that costs less than hospital stay. QRP is part of a multi-pronged approach to providing community-based services and care in the community. In SDH, all acute-care, long-term care, community-based care, and public health services are administered by one organization. QRP in SDH is successful because it exists within this integrated health care system that resulted from regionalization.

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