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The Impact of the Swedish Care Coordination Act on Hospital Readmission and Length-of-Stay among Multi-Morbid Elderly Patients: A Controlled Interrupted Time Series Analysis
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Health Services Research.ORCID iD: 0000-0001-6775-5051
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Health Services Research.
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Health Services Research.ORCID iD: 0000-0002-3921-5522
2023 (English)In: International Journal of Integrated Care, E-ISSN 1568-4156, Vol. 23, no 2, article id 17Article in journal (Refereed) Published
Abstract [en]

Coordinating follow-up care after discharge from hospital is critical to ensuring good outcomes for patients, but is difficult when multiple care providers are involved. In 2018, Sweden adopted the Care Coordination Act, which modified economic incentives to reduce discharge delays and mandated a discharge planning process for patients requiring post-discharge social-or primary care services. This study evaluates the impact of this reform on hospital length-of-stay and unplanned readmissions among multi-morbid elderly patients. Interrupted time series analysis of all in-patient care episodes involving multi-morbid elderly patients in Sweden from 2015 - 2019 (n = 2 386 039) was performed. Secondary analyses using case-mix adjustment and controlled interrupted time series analysis were employed to assess for bias. Average length of stay decreased during the post-reform period, corresponding to 248 521 saved care days. Unplanned readmissions meanwhile increased, corresponding to 7 572 excess unplanned readmissions. While reductions in length-of-stay were concentrated among patients targeted by the reform, increases in readmission rates were similar in patients not targeted by the reform, indicating potential confounding. The reform thus appears to have achieved its goal of decreasing in-patient length of stay, but a robust effect on readmissions, outpatient visits, or mortality was not found. This may be due to lackluster implementation or an ineffective mandated intervention.

Place, publisher, year, edition, pages
Ubiquity Press, 2023. Vol. 23, no 2, article id 17
Keywords [en]
care coordination, care integration, health policy, readmission, length of stay, multi-morbid elderly patients
National Category
Health Care Service and Management, Health Policy and Services and Health Economy Geriatrics
Identifiers
URN: urn:nbn:se:uu:diva-510641DOI: 10.5334/ijic.6510ISI: 001048320400001PubMedID: 37250760OAI: oai:DiVA.org:uu-510641DiVA, id: diva2:1793928
Funder
Forte, Swedish Research Council for Health, Working Life and Welfare, 2021-00678Available from: 2023-09-04 Created: 2023-09-04 Last updated: 2023-09-04Bibliographically approved

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Spangler, DouglasLinder, WilhelmWinblad, Ulrika

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