The American journal of emergency medicine · 2026
Evaluation of an emergency department-initiated community care team transitional care programme on healthcare utilisation and mortality: A retrospective cohort study.
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Teo Wesley, Vashishtha Rakhi, Chua Linus, Tan Yi En, So Stephen, Ong Colin Eng Choon
Аннотация
INTRODUCTION: Older adults frequently face fragmented transitions after leaving the Emergency Department (ED), driving up acute care usage. This study evaluated the effectiveness of an ED-initiated Community Care Team Transitional Care Programme (CCT-TCP) on post-discharge healthcare utilisation and all-cause mortality among older adults.
METHODS: A quasi-experimental retrospective cohort study utilized 1:1 propensity score matching to pair older patients (≥65 years) in CCT-TCP with non-eligible controls (n = 678 per group) between January 2023 and June 2024 at a Singapore acute hospital. Difference-in-differences (DiD) analysis via generalised estimating equations evaluated unplanned ED visits, hospital admissions, inpatient bed days, and mortality up to 180 days.
RESULTS: CCT-TCP participation was associated with significantly lower rates of inpatient bed days at 30 days (IRR 0.50; 95% CI 0.39-0.62; p < 0.001), 90 days (IRR 0.70; 95% CI 0.62-0.80; p < 0.001), and 180 days (IRR 0.83; 95% CI 0.75-0.92; p < 0.001). Mortality rates were significantly lower at 90 days (IRR 0.21; 95% CI 0.07-0.65; p = 0.007) and 180 days (IRR 0.26; 95% CI 0.11-0.60; p = 0.002), but not at 30 days (IRR 0.15; 95% CI 0.02-1.42; p = 0.098). No significant differences were observed in ED reattendance or hospital admission rates. However, a subgroup receiving home visits (n = 122) demonstrated significantly lower ED reattendance at 90 days (IRR 0.59; 95% CI 0.37-0.93; p = 0.024) and 180 days (IRR 0.66; 95% CI 0.45-0.96; p = 0.029).
DISCUSSION: An ED-initiated CCT-TCP was associated with reduced hospital bed utilisation and improved survival among older adults. While overall acute care utilisation was unchanged, targeted components such as home visits may enhance effectiveness. ED-initiated TCPs represent a promising strategy to support safe discharge and alleviate acute care pressures.
METHODS: A quasi-experimental retrospective cohort study utilized 1:1 propensity score matching to pair older patients (≥65 years) in CCT-TCP with non-eligible controls (n = 678 per group) between January 2023 and June 2024 at a Singapore acute hospital. Difference-in-differences (DiD) analysis via generalised estimating equations evaluated unplanned ED visits, hospital admissions, inpatient bed days, and mortality up to 180 days.
RESULTS: CCT-TCP participation was associated with significantly lower rates of inpatient bed days at 30 days (IRR 0.50; 95% CI 0.39-0.62; p < 0.001), 90 days (IRR 0.70; 95% CI 0.62-0.80; p < 0.001), and 180 days (IRR 0.83; 95% CI 0.75-0.92; p < 0.001). Mortality rates were significantly lower at 90 days (IRR 0.21; 95% CI 0.07-0.65; p = 0.007) and 180 days (IRR 0.26; 95% CI 0.11-0.60; p = 0.002), but not at 30 days (IRR 0.15; 95% CI 0.02-1.42; p = 0.098). No significant differences were observed in ED reattendance or hospital admission rates. However, a subgroup receiving home visits (n = 122) demonstrated significantly lower ED reattendance at 90 days (IRR 0.59; 95% CI 0.37-0.93; p = 0.024) and 180 days (IRR 0.66; 95% CI 0.45-0.96; p = 0.029).
DISCUSSION: An ED-initiated CCT-TCP was associated with reduced hospital bed utilisation and improved survival among older adults. While overall acute care utilisation was unchanged, targeted components such as home visits may enhance effectiveness. ED-initiated TCPs represent a promising strategy to support safe discharge and alleviate acute care pressures.