Healthcare pathways and resource use: mapping consequences of ambulance assessment for direct care with alternative healthcare providers

BMC Emergency Medicine

Veronica Vicente¹  Maaret Castren²  Clas Rehnberg³  Sofi Varg³  Peter Lindgren⁴ 

[1] Ambulance Medical Service in Stockholm [Ambulanssjukvården i Storstockholm AB], Stockholm, Sweden;Academic Emergency Medical Services, Stockholm, Sweden;Department of Clinical Science and Education, Karolinska Institutet, Stockholm, Sweden;Department of Clinical Science and Education, Karolinska Institutet, Stockholm, Sweden;Emergency Medicine, Helsinki University and Department of Emergency Medicine and Services, Helsinki University Hospital, Helsinki, Finland;Department of Learning, Informatics, Management and Ethics, Medical Management Centre, Karolinska Institutet, Stockholm, Sweden;Centre for Health Economics, Informatics and Health Services Research, Stockholm Health Care Services, Stockholm, Sweden;Department of Learning, Informatics, Management and Ethics, Medical Management Centre, Karolinska Institutet, Stockholm, Sweden;The Swedish Institute for Health Economics, Lund, Sweden;

关键词: Emergency medical services;    Health care costs;    Aged;    Decision support systems, clinical;    Critical pathways;    Delivery of health care;   

DOI  :  10.1186/s12873-020-00380-5

来源: Springer

【 摘 要 】

BackgroundA decision system in the ambulance allowing alternative pathways to alternate healthcare providers has been developed for older patients in Stockholm, Sweden. However, subsequent healthcare resource use resulting from these pathways has not yet been addressed. The aim of this study was therefore to describe patient pathways, healthcare utilisation and costs following ambulance transportation to alternative healthcare providers.MethodsThe design of this study was descriptive and observational. Data from a previous RCT, where a decision system in the ambulance enabled alternative healthcare pathways to alternate healthcare providers were linked to register data. The receiving providers were: primary acute care centre or secondary geriatric ward, both located at the same community hospital, or the conventional pathway to the emergency department at an acute hospital. Resource use over 10 days, subsequent to assessment with the decision system, was mapped in terms of healthcare pathways, utilisation and costs for the 98 included cases.ResultsAlmost 90% were transported to the acute care centre or geriatric ward. The vast majority arriving to the geriatric ward stayed there until the end of follow-up or until discharged, whereas patients conveyed to the acute care centre to a large extent were admitted to hospital. The median patient had 6 hospital days, 2 outpatient visits and costed roughly 4000 euros over the 10-day period. Arrival destination geriatric ward indicated the longest hospital stay and the emergency department the shortest. However, the cost for the 10-day period was lower for cases arriving to the geriatric ward than for those arriving to the emergency department.ConclusionsThe findings support the appropriateness of admittance directly to secondary geriatric care for older adults. However, patients conveyed to the acute care centre ought to be studied in more detail with regards to appropriate level of care.

【 授权许可】

CC BY