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Substudy 9 Executive Summary

Substudy 9: Costs of Acute Care Services Compared to Home Care Services

by Philip Jacobs

A number of studies have been conducted to determine the cost and effectiveness of home care in connection with acute care hospitalization. Recent reviews of the literature have concluded that the results are mixed, with home care plus hospitalization being less costly than hospitalization alone in some diagnosis, but more costly in others. The patient's condition, measured by primary diagnosis, was identified as a possible determinant of home care cost-effectiveness. We conducted an observational study, using Alberta provincial data for 1996 through 1998, to determine whether cases with home care were more or less costly than cases without home care. Our analysis was conducted on a Case Mic Group (CMG) by CMG basis. We excluded inter-hospital transfer cases, which would bias the results in some CMGs. Using non-transfer cases, and CMGs with high volumes of home care cases we determined the proportion of cases within individual CMGs which had home care, and the hospital and home care cost components for these cases. In virtually all study CMGs, cases with home care were more costly than those without home care.

We further studied the CMGs to determine whether home care cases were similar to cases without home care. For each study CMG, we analyzed the number of diagnoses per case, which served as a severity index. In virtually all CMGs, CMGs, cases with home care had more diagnoses than did cases in the same CMG without home care. This indicates that CMGs with home care have a higher degree of severity than those without. Our results imply that case severity is an important indicator of home care assignment. Under real-world conditions, that is, those in charge of allocating acute care patients to home care have deemed more severe patients to have a greater "need" for these services.