Cost-Savings of Primary Healthcare Nurse Practitioners' Planned Interventions for Reducing Transfers of Patients from Home Care to Emergency Departments in Quebec, Canada
Author(s)
Eric Tchouaket, PhD1, Kelley Kilpatrick, PhD2, Mira Jabbour, MSc.3, Fatima El-Mousawi, MSc.1;
1Université du Québec en Outaouais, Nursing, St.Jérôme, QC, Canada, 2McGill University, Ingram School of Nursing, Montreal, QC, Canada, 3Maissoneuve Rosemont Hospital, CIUSSS de l'Est-de-l'Île-de-Montréal du Québec, Montreal, QC, Canada
1Université du Québec en Outaouais, Nursing, St.Jérôme, QC, Canada, 2McGill University, Ingram School of Nursing, Montreal, QC, Canada, 3Maissoneuve Rosemont Hospital, CIUSSS de l'Est-de-l'Île-de-Montréal du Québec, Montreal, QC, Canada
Presentation Documents
OBJECTIVES: Integrating primary healthcare nurse practitioners (PHCNPs) into home care services increases the availability of healthcare, reduces hospitalizations, and limits emergency department (ED) transfers, especially when PHCNPs plan the interventions. The economic benefits of reducing transfers to the ED remain underexplored. This study assessed the cost-savings associated with PHCNP-planned interventions during patient transfers from home care to EDs.
METHODS: Data were collected from 343 patients receiving home care services and being followed by six PHCNPs between November 1, 2021, and May 4, 2022, in Québec, Canada. A literature review was performed to evaluate costs associated with patient transfers from home care to EDs. Time-Driven Activity-Based Costing assessed the costs of PHCNP planned interventions. Cost-savings were calculated as the net gains from reduced transfers achieved through PHCNP planned interventions and were reported in 2022 Canadian dollars (CAD). Sensitivity analyses, with 1,000 random simulations and discounting were used to estimate the median transfer costs, intervention costs, and cost-savings.
RESULTS: A total of 2,839 interventions occurred. Of these, 1,819 were planned and 1,020 were not. The cost difference between planned and unplanned interventions was not statistically significant (p = 0.445). However, planned interventions significantly reduced patient transfers by a factor of 7.1 (OR range: 2.7-18.4, p < 0.001) compared to unplanned interventions, when controlling for patient age, gender, health conditions and contextual factors. The reduction in median costs attributable to planned interventions, ranged from CAD 17,370 to CAD 50,230 per avoided transfer.
CONCLUSIONS: This study demonstates that PHCNP-planned interventions reduce patient transfers to EDs compared to unplanned interventions. This reduction resulted in substantial cost-savings, highlighting the value of PHCNP regular follow-up in enhancing home care quality and safety. These findings offer insights for policy development and the integration of PHCNP planned interventions in home care settings.
METHODS: Data were collected from 343 patients receiving home care services and being followed by six PHCNPs between November 1, 2021, and May 4, 2022, in Québec, Canada. A literature review was performed to evaluate costs associated with patient transfers from home care to EDs. Time-Driven Activity-Based Costing assessed the costs of PHCNP planned interventions. Cost-savings were calculated as the net gains from reduced transfers achieved through PHCNP planned interventions and were reported in 2022 Canadian dollars (CAD). Sensitivity analyses, with 1,000 random simulations and discounting were used to estimate the median transfer costs, intervention costs, and cost-savings.
RESULTS: A total of 2,839 interventions occurred. Of these, 1,819 were planned and 1,020 were not. The cost difference between planned and unplanned interventions was not statistically significant (p = 0.445). However, planned interventions significantly reduced patient transfers by a factor of 7.1 (OR range: 2.7-18.4, p < 0.001) compared to unplanned interventions, when controlling for patient age, gender, health conditions and contextual factors. The reduction in median costs attributable to planned interventions, ranged from CAD 17,370 to CAD 50,230 per avoided transfer.
CONCLUSIONS: This study demonstates that PHCNP-planned interventions reduce patient transfers to EDs compared to unplanned interventions. This reduction resulted in substantial cost-savings, highlighting the value of PHCNP regular follow-up in enhancing home care quality and safety. These findings offer insights for policy development and the integration of PHCNP planned interventions in home care settings.
Conference/Value in Health Info
2025-05, ISPOR 2025, Montréal, Quebec, CA
Value in Health, Volume 28, Issue S1
Code
EE241
Topic
Economic Evaluation
Disease
No Additional Disease & Conditions/Specialized Treatment Areas