A Multidisciplinary, Community-Based Program to Reduce Unplanned Hospital Admissions.

Area of Science:

• Healthcare Management
• Chronic Disease Management
• Health Services Research

Background:

• High-risk individuals often experience frequent hospitalizations, leading to increased healthcare costs and burden.
• The Hospital Admission Risk Program (HARP) was implemented to provide multidisciplinary, community-based care support to mitigate these issues.

Purpose of the Study:

• To evaluate the impact of HARP on unplanned hospitalizations, bed days, and mortality.
• To assess the cost-effectiveness of the HARP intervention.

Main Methods:

• A retrospective longitudinal analysis of hospital administrative data from 1553 individuals enrolled in HARP between July 2017 and June 2018.
• Comparison of hospital admissions and bed days 18 months before and after HARP enrollment.
• Analysis of total hospital costs pre- and post-intervention.

Main Results:

• HARP intervention led to reductions in unplanned hospitalizations and bed days compared to the pre-enrollment period.
• Specific HARP programs (cardiac coach, diabetes comanagement, medication management) showed reduced hospital costs.
• Higher mortality rates were observed in cardiac heart failure and chronic respiratory management programs.

Conclusions:

• HARP effectively reduced unplanned hospitalizations and bed days, but did not fully restore hospital use to baseline levels.
• Variations in mortality across different HARP programs indicate the need for tailored, condition-specific management goals.