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Impact of integrated care on trends in the rate of emergency department visits among older persons in Stockholm County: an interrupted time series analysis

OBJECTIVE: To investigate the association between the implementation of an integrated care (IC) system in Norrtälje municipality and changes in trends of the rate of emergency department (ED) visits. DESIGN: Interrupted time series analysis from 2000 to 2015. SETTING: Stockholm County. PARTICIPANTS:...

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Autores principales: Doheny, Megan, Agerholm, Janne, Orsini, Nicola, Schön, Pär, Burström, Bo
Formato: Online Artículo Texto
Lenguaje:English
Publicado: BMJ Publishing Group 2020
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7279653/
https://www.ncbi.nlm.nih.gov/pubmed/32499268
http://dx.doi.org/10.1136/bmjopen-2019-036182
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author Doheny, Megan
Agerholm, Janne
Orsini, Nicola
Schön, Pär
Burström, Bo
author_facet Doheny, Megan
Agerholm, Janne
Orsini, Nicola
Schön, Pär
Burström, Bo
author_sort Doheny, Megan
collection PubMed
description OBJECTIVE: To investigate the association between the implementation of an integrated care (IC) system in Norrtälje municipality and changes in trends of the rate of emergency department (ED) visits. DESIGN: Interrupted time series analysis from 2000 to 2015. SETTING: Stockholm County. PARTICIPANTS: All inhabitants 65+ years in Stockholm County on 31 December of each study year. INTERVENTION: IC was established by combining the funding, administration and delivery of health and social care for older persons in Norrtälje municipality, within Stockholm County. OUTCOME: Rates of hospital-based ED visits. RESULTS: IC was associated with a decrease in the rate of ED visits (incidence rate ratio: 0.997, 95% CI 0.995 to 0.998) among inhabitants 65+ years in Norrtälje. However, the rate of ED visits remained higher in Norrtälje than the rest of Stockholm in the preintervention and postintervention periods. Stratified analyses showed that IC was associated with a decline in the trend of the rate of ED visits among those 65–79 years, the lowest income group and born outside of Sweden. However, there was no significant decrease in the trend among those 80+ years. CONCLUSION: The implementation of IC was associated with a modest change in the trend of ED visits in Norrtälje, though the rate of ED visits remained higher than in the rest of Stockholm. Changes in the composition of the population and contextual changes may have impacted our findings. Further research, using other outcome measures is needed to assess the impact of IC on healthcare utilisation.
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spelling pubmed-72796532020-06-15 Impact of integrated care on trends in the rate of emergency department visits among older persons in Stockholm County: an interrupted time series analysis Doheny, Megan Agerholm, Janne Orsini, Nicola Schön, Pär Burström, Bo BMJ Open Health Policy OBJECTIVE: To investigate the association between the implementation of an integrated care (IC) system in Norrtälje municipality and changes in trends of the rate of emergency department (ED) visits. DESIGN: Interrupted time series analysis from 2000 to 2015. SETTING: Stockholm County. PARTICIPANTS: All inhabitants 65+ years in Stockholm County on 31 December of each study year. INTERVENTION: IC was established by combining the funding, administration and delivery of health and social care for older persons in Norrtälje municipality, within Stockholm County. OUTCOME: Rates of hospital-based ED visits. RESULTS: IC was associated with a decrease in the rate of ED visits (incidence rate ratio: 0.997, 95% CI 0.995 to 0.998) among inhabitants 65+ years in Norrtälje. However, the rate of ED visits remained higher in Norrtälje than the rest of Stockholm in the preintervention and postintervention periods. Stratified analyses showed that IC was associated with a decline in the trend of the rate of ED visits among those 65–79 years, the lowest income group and born outside of Sweden. However, there was no significant decrease in the trend among those 80+ years. CONCLUSION: The implementation of IC was associated with a modest change in the trend of ED visits in Norrtälje, though the rate of ED visits remained higher than in the rest of Stockholm. Changes in the composition of the population and contextual changes may have impacted our findings. Further research, using other outcome measures is needed to assess the impact of IC on healthcare utilisation. BMJ Publishing Group 2020-06-03 /pmc/articles/PMC7279653/ /pubmed/32499268 http://dx.doi.org/10.1136/bmjopen-2019-036182 Text en © Author(s) (or their employer(s)) 2020. Re-use permitted under CC BY. Published by BMJ. https://creativecommons.org/licenses/by/4.0/This is an open access article distributed in accordance with the Creative Commons Attribution 4.0 Unported (CC BY 4.0) license, which permits others to copy, redistribute, remix, transform and build upon this work for any purpose, provided the original work is properly cited, a link to the licence is given, and indication of whether changes were made. See: https://creativecommons.org/licenses/by/4.0/.
spellingShingle Health Policy
Doheny, Megan
Agerholm, Janne
Orsini, Nicola
Schön, Pär
Burström, Bo
Impact of integrated care on trends in the rate of emergency department visits among older persons in Stockholm County: an interrupted time series analysis
title Impact of integrated care on trends in the rate of emergency department visits among older persons in Stockholm County: an interrupted time series analysis
title_full Impact of integrated care on trends in the rate of emergency department visits among older persons in Stockholm County: an interrupted time series analysis
title_fullStr Impact of integrated care on trends in the rate of emergency department visits among older persons in Stockholm County: an interrupted time series analysis
title_full_unstemmed Impact of integrated care on trends in the rate of emergency department visits among older persons in Stockholm County: an interrupted time series analysis
title_short Impact of integrated care on trends in the rate of emergency department visits among older persons in Stockholm County: an interrupted time series analysis
title_sort impact of integrated care on trends in the rate of emergency department visits among older persons in stockholm county: an interrupted time series analysis
topic Health Policy
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7279653/
https://www.ncbi.nlm.nih.gov/pubmed/32499268
http://dx.doi.org/10.1136/bmjopen-2019-036182
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