Abstract
Background: Hospitals face significant challenges during winter due to the seasonal influx of patients with illnesses such as influenza and COVID-19, a phenomenon known as the "Winter Surge." East Toronto Health Partners, in their efforts to build an integrated care system across settings, aimed to address this issue by facilitating early discharges and supporting patients' transitions from hospital to home through a collaborative initiative called the Hospital Nice Fund (HNF). The HNF program exemplifies a community-enabled partnership designed to improve population health and well-being. Its goal was to expedite discharge for clinically cleared patients facing social barriers by providing community or home care services. This project aimed to conduct an outcome evaluation using quantitative methods, with findings intended to inform future investments in collaborative care efforts.
Approach: We evaluated healthcare utilization among HNF enrollees compared to similar patients not enrolled in the program. Using propensity scores, we matched HNF enrollees with a control group in a 1:3 ratio and employed a difference-in-differences approach with generalized estimating equations to assess the association between HNF enrollment and key outcomes: hospital length of stay (LOS), 7-day emergency department (ED) visits, and 30-day hospital readmissions. The study period spanned from December 1, 2018, to April 30, 2022.
Results: A total of 456 control patients were matched to 152 HNF enrollees. After matching, baseline covariates between the two groups were balanced, with standardized differences below 0.10. The mean age of enrollees was 72.8 years, and 51% were male.
Preliminary results showed that, although not statistically significant, HNF participants had longer hospital stays (an average of 4.1 days) compared to non-HNF patients. Additionally, 30-day readmission rates were higher among HNF participants, with approximately three times the odds of readmission compared to non-HNF patients. Similarly, 7-day ED visits were more frequent among HNF participants, with the odds of an ED visit being about 5.5 times higher than for non-enrollees. These findings suggest that the HNF program may need adjustments to improve patient flow during the Winter Surge.
Implications: This study is among the few that utilized advanced quantitative methods to evaluate the outcomes of integrated care, focusing on its impact rather than implementation. The findings highlight the critical role of integrated care in advancing health outcomes but also suggest that adjustments to the HNF program may be needed.
The decision to avoid strict enrollment criteria likely facilitated discharges by enrolling patients with longer LOS to free up beds. However, this may indicate that the program’s inclusion criteria or goals need refinement to better align with patient needs. Additional community or home-based support may also be necessary to prevent readmissions and ED visits. Further investigation is required to determine how the program can be optimized to enhance patient flow and outcomes.