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Applying embedded program evaluation for care delivery transformation: An analysis of a home-based urgent care
Lucas C Carlson1,2, Charles T Pu1,3, Eden Mark1
1Population Health Management, Mass General Brigham Boston Massachusetts USA.
Health Science Reports
|September 2, 2022
Summary
The Partners Mobile Observation Unit (PMOU) program aimed to reduce healthcare utilization for homebound patients. However, this evaluation found no significant impact on emergency department visits, hospitalizations, or total medical expenditure.
Area of Science:
- Geriatrics
- Health Services Research
- Urgent Care Medicine
Background:
- Mass General Brigham launched the Partners Mobile Observation Unit (PMOU) in 2014.
- The program provides urgent, home-based medical care for homebound patients and older adults with frailty or limited mobility.
Purpose of the Study:
- To evaluate the impact of the PMOU program on postreferral healthcare utilization and total medical expenditure (TME).
Main Methods:
- A pragmatic, embedded evaluation using propensity weighting and logistic regression.
- Compared 891 PMOU episodes with 57 non-enrolled control episodes from April 2017 to June 2018.
- Difference-in-differences analysis assessed TME changes 30 days pre/post referral.
Main Results:
- No statistically significant differences in 30-day postreferral emergency department visits (OR=0.83) or hospitalizations (OR=0.64) between PMOU and control groups.
- No significant difference in pre/post referral TME for PMOU versus control episodes (p=0.64).
- Post hoc analysis revealed 75% of control episodes received care elsewhere within 14 days of referral.
Conclusions:
- The mature PMOU program did not demonstrate statistically significant reductions in healthcare utilization or TME.
- Future home-based urgent care programs should enhance patient targeting and operational efficiency.
- Improvements are needed to generate meaningful reductions in healthcare utilization and spending for vulnerable populations.
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