Abstract
This two-arm randomized controlled trial evaluated the impact of a Stepped-Care intervention (predictive analytics combined with tailored interventions) on the healthcare costs of older adults using a Personal Emergency Response System (PERS). A total of 370 patients aged 65 and over with healthcare costs in the middle segment of the cost pyramid for the fiscal year prior to their enrollment were enrolled for the study. During a 180-day intervention period, control group (CG) received standard care, while intervention group (IG) received the Stepped-Care intervention. The IG had 31% lower annualized inpatient cost per patient compared with the CG (3.7 K, $8.1 K vs. $11.8 K, p = 0.02). Both groups had similar annualized outpatient costs per patient ($6.1 K vs. $5.8 K, p = 0.10). The annualized total cost reduction per patient in the IG vs. CG was 20% (3.5 K, $17.7 K vs. $14.2 K, p = 0.04). Predictive analytics coupled with tailored interventions has great potential to reduce healthcare costs in older adults, thereby supporting population health management in home or community settings.
Highlights
COVID-19 has profoundly changed health systems around the world and highlighted the importance of accelerating digital medicine[1]
The Stepped-Care intervention reduced the annualized total healthcare cost per patient in the intervention group (IG) compared to the control group (CG) by $3.5 K (20%, $14.2 K vs. $17.7 K, p = 0.04)
This reduction was driven by the $3.7 K lower annualized inpatient costs per patient in the IG compared to the CG (31%, $8.1 K vs. $11.8 K, p = 0.02) as both groups had similar annualized outpatient cost per patient ($6.1 K vs. $5.8 K, p = 0.10)
Summary
COVID-19 has profoundly changed health systems around the world and highlighted the importance of accelerating digital medicine[1]. PERS services have been improved with a predictive model that utilizes PERS data to identify patients at risk of ED transports[5] Such risk predictions can support healthcare providers to proactively intervene and potentially prevent unnecessary healthcare utilization and costs in older patients. Our previously published longitudinal retrospective study of healthcare costs of an older population has shown that the middle segment was persistently the costliest segment through all 5 years with the highest increase in annualized costs compared with the other segments[13] Informed by these key findings, this study focuses on patients in the middle segment of the cost pyramid. We were not able to combine clinical and financial outcomes in one paper as the cost data were available for analysis 8 months after the clinical outcomes data
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