Abstract
Little is known about the effects of seamless hospital discharge planning on long-term care (LTC) costs and effectiveness. This study evaluates the cost and effectiveness of the recently implemented policy from hospital to LTC between patients discharged under seamless transition and standard transition. A total of 49 elderly patients in the standard transition cohort and 119 in the seamless transition cohort were recruited from November 2016 to February 2018. Data collected from medical records included the Multimorbidity Frailty Index, Activities of Daily Living Scale, and Malnutrition Universal Screening Tool during hospitalization. Multiple linear regression and Cox regression models were used to explore risk factors for medical resource utilization and medical outcomes. After adjustment for effective predictors, the seamless cohort had lower direct medical costs, a shorter length of stay, a higher survival rate, and a lower unplanned readmission rate compared to the standard cohort. However, only mean total direct medical costs during hospitalization and 6 months after discharge were significantly (p < 0.001) lower in the seamless cohort (USD 6192) compared to the standard cohort (USD 8361). Additionally, the annual per-patient economic burden in the seamless cohort approximated USD 2.9–3.3 billion. Analysis of the economic burden of disability in the elderly population in Taiwan indicates that seamless transition planning can save approximately USD 3 billion in annual healthcare costs. Implementing this policy would achieve continuous improvement in LTC quality and reduce the financial burden of healthcare on the Taiwanese government.
Highlights
Advances in medicine and sanitation in developed countries have achieved consistent annual increases in average life expectancy [1]
191 patients were enrolled in the standard transition group, and 156 patients were simultaneously enrolled in the seamless transition group (Figure 1)
This study revealed that the seamless cohort had significantly (p < 0.05) lower total direct medical costs compared to the standard cohort
Summary
Advances in medicine and sanitation in developed countries have achieved consistent annual increases in average life expectancy [1]. One literature review indicated that a structured discharge plan tailored to the individual patient is likely to decrease hospital stay, decrease readmission rate, and increase patient satisfaction but has an unknown impact on health outcomes [7]. Another systematic review of randomized, controlled, or quasi-experimental trials was performed in 2000–2009 to investigate how discharge planning from hospital to home affects health outcomes in patients aged 65 years or older [8]. In these patients, discharge planning had large effects on satisfaction but only moderate effects on quality of life and readmission rate
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