Cost‐Effectiveness of a Care Transitions Program in a Multimorbid Older Adult Cohort

• Published in: Journal of the American Geriatrics Society (JAGS) 2018-02, Vol.66 (2), p.297-301
• Main Authors: Hanson, Gregory J., Borah, Bijan J., Moriarty, James P., Ransom, Jeanine E., Naessens, James M., Takahashi, Paul Y.
• Format: Article
• Language: English
• Subjects: Aged, 80 and over; care transitions; Comorbidity; Cost control; Cost Savings; Cost-Benefit Analysis; costs; Data processing; Female; Health Care Costs; Hospitalization - economics; Humans; Male; Minnesota; Older people; Patient Discharge; Patient Readmission - economics; Patient Transfer - economics; Patient Transfer - methods; readmissions; Retrospective Studies; Statistical analysis
• ISSN: 0002-8614; 1532-5415
• DOI: 10.1111/jgs.15203

Background/Objectives Facing penalties for preventable 30‐day hospital readmissions, many provider groups have implemented programs to remedy this problem, but the cost efficacy and value of such programs are not well delineated. The objective was to compare total cost of care over 30 days of individuals enrolled in the Mayo Clinic Care Transitions (MCCT) program and individuals not enrolled. Design Retrospective cohort study using secondary data analysis of a previously published cohort study. Setting Mayo Clinic, Rochester, Minnesota. Participants MCCT participants (n = 363) and individuals in a propensity‐matched referent cohort (n = 365). Intervention MCCT program enrollment. Measurements The primary outcome was total cost of care over 30 days after hospital discharge. A 2‐part modeling strategy was used to analyze 30‐day costs: whether individuals had non‐zero costs during the 30 days after discharge and a generalized linear model for individuals who incurred costs. Potential heterogeneous effects of the MCCT program were examined according to decile of 30‐day costs using quantile regression. Results Mean age was 83 in both groups. Adjusted mean 30‐day cost after hospitalization was $3,363 (95% confidence interval (CI) = $2,512−4,213) in the MCCT group and $4,161 (95% CI = $3,096−5,226) in the control group (P = .25). Cost savings of $2,744 (P = .008) at the eighth decile and $3,388 (P = .20) at the ninth decile were demonstrated. Thus, the only statistically significant differences were in the post hoc subgroup analysis in the highest‐cost subgroups. Conclusion We did not find a difference in overall mean costs between the MCCT group and the control group, although intervention participants in the upper deciles of costs appeared to experience lower costs than controls. A larger study cohort might better determine the value of the intervention.