Association of a Geriatric Emergency Department Innovation Program With Cost Outcomes Among Medicare Beneficiaries
| Autor: | Corita Grudzen, James G. Adams, Carolyn W. Zhu, Carmen Vargas-Torres, Melissa M. Garrido, George T. Loo, Daniel S. Cruz, D. Mark Courtney, Ula Hwang, Jeremy Sze, Structural Enhancement Investigators, Scott M. Dresden, Kevin M Baumlin, Amer Z. Aldeen, Lynne D. Richardson, Gloria Nimo, Raymond Kang, Stephanie J. Gravenor |
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| Rok vydání: | 2021 |
| Předmět: |
Emergency Medical Services
Social Work medicine.medical_specialty Health Services for the Aged Psychological intervention Beneficiary Medicare Cost Savings medicine Humans Transitional care Hospital Costs Geriatric Assessment Referral and Consultation Reimbursement Aged Original Investigation Aged 80 and over Receipt Geriatrics business.industry Research Correction Fee-for-Service Plans Transitional Care General Medicine Emergency department Hospitals United States humanities Online Only Cross-Sectional Studies Family medicine Workforce Emergency Medicine Patient Care Other Emergency Service Hospital business |
| Zdroj: | JAMA Network Open |
| ISSN: | 2574-3805 |
| DOI: | 10.1001/jamanetworkopen.2020.37334 |
| Popis: | This cross-sectional study assesses the association of geriatric emergency department program implementation with Medicare costs per beneficiary. Key Points Question Is there an association between geriatric emergency department (ED) programs and total costs of care for Medicare? Findings In this cross-sectional study of 24 839 Medicare fee-for-service beneficiaries at 2 EDs, there was a significant association with reduced total costs of care after being seen by either a transitional care nurse and/or social worker trained to deliver geriatric emergency care. Per beneficiary, these savings were as much as $2905 after 30 days and $3202 after 60 days of the index ED visit. Meaning These findings suggest that geriatric emergency department care programs may be associated with savings value to hospitals and payers. Importance There has been a significant increase in the implementation and dissemination of geriatric emergency department (GED) programs. Understanding the costs associated with patient care would yield insight into the direct financial value for patients, hospitals, health systems, and payers. Objective To evaluate the association of GED programs with Medicare costs per beneficiary. Design, Setting, and Participants This cross-sectional study included data on Medicare fee-for-service beneficiaries at 2 hospitals implementing Geriatric Emergency Department Innovations in Care Through Workforce, Informatics, and Structural Enhancement (GEDI WISE) (Mount Sinai Medical Center [MSMC] and Northwestern Memorial Hospital [NMH]) from January 1, 2013, to November 30, 2016. Analyses were conducted and refined from August 28, 2018, to November 20, 2020, using entropy balance to account for observed differences between the treatment and comparison groups. Interventions Treatment included consultation with a transitional care nurse (TCN) or a social worker (SW) trained for the GEDI WISE program at a beneficiary’s first ED visit (index ED visit). The comparison group included beneficiaries who were never seen by either a TCN or an SW during the study period. Main Outcomes and Measures The main outcome evaluated was prorated total Medicare payer expenditures per beneficiary over 30 and 60 days after the index ED visit encounter. Results Of the total 24 839 unique Medicare beneficiaries, 4041 were seen across the 2 EDs; 1947 (17.4%) at MSMC and 2094 (15.4%) at the NMH received treatment from either a GED TCN and/or a GED SW. The mean (SD) age of beneficiaries at MSMC was 78.8 (8.5) years and at NMH was 76.4 (7.7) years. Most patients at both hospitals were female (6821 [60.8%] at MSMC and 8023 [58.9%] at NMH) and White (7729 [68.9%] at MSMC and 9984 [73.3%] at NMH). Treatment was associated with statistically significant mean savings per beneficiary of $2436 (95% CI, $1760-$3111; P |
| Databáze: | OpenAIRE |
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