Presentation (CTI)

OBJECTIVES: Nursing home residents are frequently hospitalized for the evaluation of health issues such as infections, falls, or cardiovascular disorders. Due to the frailty and multimorbidity of this population, hospital stays are often associated with adverse outcomes, including delirium, further falls, pressure ulcers, and depression. Improved access to timely diagnostics and medical care within nursing homes could reduce such admissions and alleviate pressure on hospital emergency departments. The DIKOM project introduces a Mobile Geriatric Unit (MGU) — a vehicle equipped with diagnostic tools including CT, X-ray, ECG, EEG, ultrasound, and laboratory facilities — to provide specialist-led diagnostics directly at the nursing home. This approach is expected to enable in-place treatment and improve care continuity.
METHODS: A health economic model was developed to assess the cost-effectiveness of the MGU intervention in the context of a cluster-randomized controlled trial. The model integrates trial design parameters, epidemiological data, and cost estimates from the literature to simulate multiple implementation scenarios. This modeling approach follows the principles of value-of-information (VOI) analysis to inform and prioritize data collection.
RESULTS: Preliminary simulation results suggest that reductions in hospital admissions and associated complications are key drivers of the MGU’s cost-effectiveness. The analysis identifies critical parameters—such as the prevalence of avoidable admissions, the cost of MGU deployment, and the effectiveness of the MGU — that have the greatest influence on the expected outcomes. These insights inform the most valuable outcome measures for the trial and highlight where empirical uncertainty most strongly affects the intervention's value proposition.
CONCLUSIONS: This study demonstrates the value of simulation-based modeling to guide the evaluation of complex health service interventions. In the case of DIKOM, early economic modeling helps to clarify the potential impact of a Mobile Geriatric Unit on care quality and resource use in nursing homes. It also supports evidence-informed decision-making by identifying the most policy-relevant outcomes.