Avoiding Hospital Admissions and Delayed Transfers of Care by Improved Access to Intermediate Care: A Simulation Study.

Autor:	Arntzen RJ; Department of Mathematics, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands; Stochastics group, Centrum Wiskunde & Informatica, Amsterdam, the Netherlands. Electronic address: rebekka.arntzen@cwi.nl., van den Besselaar JH; Section of Geriatric Medicine, Department of Internal Medicine, Amsterdam Public Health Research Institute, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands., Bekker R; Department of Mathematics, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands., Buurman BM; Section of Geriatric Medicine, Department of Internal Medicine, Amsterdam Public Health Research Institute, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands., van der Mei RD; Department of Mathematics, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands; Stochastics group, Centrum Wiskunde & Informatica, Amsterdam, the Netherlands.
Jazyk:	angličtina
Zdroj:	Journal of the American Medical Directors Association [J Am Med Dir Assoc] 2023 Jul; Vol. 24 (7), pp. 945-950.e4. Date of Electronic Publication: 2023 Jun 05.
DOI:	10.1016/j.jamda.2023.04.026
Abstrakt:	Objective: The current waiting times for intermediate care in the Netherlands prohibit timely access, leading to unwanted and costly hospital admissions. We propose alternative policies for improvement of intermediate care and estimate the effects on the waiting times, hospitalization, and the number of patient replacements. Design: Simulation study. Setting and Participants: For our case study, data were used of older adults who received intermediate care in Amsterdam, the Netherlands, in 2019. For this target group, in- and outflows and patient characteristics were identified. Methods: A process map of the main pathways into and out of the intermediate care was obtained and a discrete event simulation (DES) was built. We demonstrate the use of our DES for intermediate care by evaluating possible policy changes for a real-life case study in Amsterdam. Results: By means of a sensitivity analysis with the DES, we show that in Amsterdam the waiting times are not a result of a lack in bed capacity but are due to an inefficient triage and application process. Older adults have to wait a median of 1.8 days for admission, leading to hospitalization. If the application process becomes more efficient and evening and weekend admissions are allowed, we find that unwanted hospitalization can be decreased substantially. Conclusion and Implications: In this study, a simulation model is developed for intermediate care that can serve as a basis for policy decisions. Our case study shows that the waiting times for health care facilities are not always solved by increasing bed capacity. This underlines the necessity for a data-driven approach to identify logistic bottlenecks and find the best ways to solve them. (Copyright © 2023 The Authors. Published by Elsevier Inc. All rights reserved.)
Databáze:	MEDLINE
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