The effect of a mobile integrated health program on health care cost and utilization.

Abstract

OBJECTIVE\nTo measure the effect of a mobile integrated health community paramedicine (MIH-CP) transitional care program on hospital utilization, emergency department visits, and charges.\n\n\nDATA SOURCES\nRetrospective secondary data from the electronic health record and regional health information exchange were used to analyze patients discharged from a large academic medical center and an affiliated community hospital in Baltimore, Maryland, May 2018-October 2019.\n\n\nSTUDY DESIGN\nWe performed an observational study comparing patients enrolled in an MIH-CP program to propensity-matched controls. Propensity scores were calculated using measures of demographics, clinical characteristics, social determinants of health, and prior health care utilization. The primary outcome is inpatient readmission within 30\u2009days of discharge. Secondary outcomes include excess days in acute care 30\u2009days after discharge and emergency department visits, observation hospitalizations, and total health care charges within 30 and 60\u2009days of discharge.\n\n\nDATA COLLECTION\nIncluded patients were over 18\u2009years old, discharged to home from internal/family medicine services, and live in eligible ZIP codes. The intervention group was enrolled in the MIH-CP program; controls met inclusion criteria but were not enrolled during the study period.\n\n\nPRINCIPAL FINDINGS\nThe adjusted model showed no difference in 30-day inpatient readmission between 464 enrolled patients and propensity-matched controls (adjusted incidence rate ratio\xa0=\xa01.19, 95% confidence interval [CI] [0.89, 1.60]). There was a higher rate of observation hospitalizations within 30\u2009days of index discharge for MIH-CP patients (adjusted incidence rate ratio\xa0=\xa01.78, 95% CI\xa0=\xa0[1.01, 3.14]). This difference did not persist at 60\u2009days, and there were no differences in other secondary outcomes.\n\n\nCONCLUSIONS\nWe found no significant difference in short-term health care utilization or charges between patients enrolled in an MIH-CP transitional care program and propensity-matched controls. This highlights the importance of well-controlled, robust evaluations of effectiveness in novel care-delivery systems.