The cost-effectiveness of a nursing home-based transitional care unit for increasing the potential for independent living in the community among hospitalized older adults
Bibliographic record
Abstract
In Canada, a persistent barrier to achieving healthcare system efficiency has been patient days accumulated by individuals with an alternate level of care (ALC) designation. Transitional care units (TCUs) may address the capacity pressures associated with ALC. We sought to assess the cost-effectiveness of a nursing home (NH) based TCU leveraging existing infrastructure to support a hospitalized older adult’s transition to independent living at home. This case-control study included frail, older adults who received care within a function-focused TCU following a hospitalization between 1 March 2018 and 30 June 2019. TCU patients were propensity score matched to hospitalized ALC patients (“usual care”). The primary outcome was days without requiring institutional care six months following discharge, defined as institutional-free days. This was calculated by excluding all days in hospitals, rehabilitation facilities, complex continuing care facilities and NHs. Using the total direct cost of care up to discharge from TCU or hospital, the incremental cost-effectiveness ratio was calculated. TCU patients spent, on average, 162.0 days institution-free (95% CI: 156.3–167.6d) within six months days post-discharge, while usual care patients spent 140.6 days institution-free (95% CI: 132.3–148.8d). TCU recipients had a lower total cost of care, by CAN$1,106 (95% CI: $–6,129–$10,319), due to the reduced hospital length of stay (mean [SD] 15.6d [13.3d] for TCU patients and 28.6d [67.4d] days for usual care). TCU was deemed the more cost-effective model of care. The main limitation was the potential inclusion of patients not eligible for SAFE in our usual group. To minimize this selection bias, we expanded the geographical pool of ALC patients to patients with SAFE admission potential in other area hospitals. Through rehabilitative and restorative care, TCUs can reduce hospital length of stay, increase potential for independent living, and reduce risk for subsequent institutionalization. A persistent barrier to achieving efficiency within the Canadian healthcare system has been days accumulated by patients who no longer require the intensity of hospital care but are waiting to be discharged to more appropriate care settings. Prolonged hospital stays are known to expose patients to various health risks. Transitional care units are care settings designed to improve care continuation for patients moving between different locations or levels of care. They an opportunity to address the capacity pressures and health risks associated with prolonged hospital stays. Studies have demonstrated the effectiveness of transitional care units to improve outcomes among older adults, such as reducing hospital length of stay, nursing home placement, and falls, as well as improving functional status, quality of life, and likelihood of being discharged home. However, the financial implications of transitional care units, in terms of resources required to operate their services, and value for money are not well understood. This study found that a nursing home-based, function-focused transitional care unit reduced the length of stay in hospitals and the risk for subsequent institutionalization among frail, older adults. This was achieved at a lower total cost of care. Older adults who received transitional care were able to remain at home for three weeks longer without requiring institutional care compared to those who did not receive transitional care. Considering the growing investments in transitional care, this research provides evidence supporting nursing home-based transitional care programs.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.003 | 0.011 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.002 |
| Bibliometrics | 0.001 | 0.001 |
| Science and technology studies | 0.000 | 0.001 |
| Scholarly communication | 0.001 | 0.001 |
| Open science | 0.001 | 0.001 |
| Research integrity | 0.001 | 0.001 |
| Insufficient payload (model declined to judge) | 0.001 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".