Association of volunteer-administered home care with reduced emergency room visits and hospitalization among older adults with chronic conditions: a propensity-score-matched cohort study

Abstract

Objectives The objective of this study was to examine the association of receiving care from a volunteer-administered outreach program with emergency room utilization and hospitalization among older people with chronic conditions in Hong Kong. Methods Volunteers consisting of retired healthcare professionals, university students, and openly recruited citizens received training to provide home care services to hospital-discharged older Chinese adults aged 65+ with chronic conditions who were identified as high-risk patients of hospital admission and referred by public healthcare providers. Several home visits were made to enhance the patients’ self-care capacity. For comparison, a 4:1-propensity score matching based on age, sex, the month of discharge, length of stay for the index episode, and 14 common chronic conditions was conducted to select a comparison group from a territory-wide inpatient database. Poisson regression was used to compare emergency room utilization and the number of hospitalized days. Results In total, 775 patients were analyzed, including 155 home care recipients and 620 extracted from the inpatient database as a matched comparison with similar baseline characteristics. Regression analysis showed that home care recipients had 21% fewer overall emergency room visits [95% confidence interval (CI): 3% - 35%], 22% fewer such visits which led to hospitalization (95% CI: 1% - 39%) and 22% fewer overall hospitalized days (95% CI: 16% - 28%). Nevertheless, the number of hospitalized days admitted through the emergency room was 10% higher among home care recipients (95% CI: 0% - 20%). Conclusions Volunteer-administered home care might be effective in reducing emergency room visits and non-acute hospitalization, as well as early detection of acute problems warranting tertiary care. Further randomized studies are needed to substantiate this finding.