TY - JOUR
T1 - Avoiding Hospital Admissions and Delayed Transfers of Care by Improved Access to Intermediate Care
T2 - A Simulation Study
AU - Arntzen, Rebekka J.
AU - van den Besselaar, Judith H.
AU - Bekker, René
AU - Buurman, Bianca M.
AU - van der Mei, Rob D.
N1 - Funding Information: This research is funded by the Open Technology Program of the Dutch Research Council (NWO), project number 17710, with the name DOLCE VITA (Data-driven Optimization for a Vital Elderly Care System in the Netherlands). Publisher Copyright: © 2023 The Authors
PY - 2023/7/1
Y1 - 2023/7/1
N2 - Objective: The current waiting times for intermediate care in the Netherlands prohibit timely access, leading to unwanted and costly hospital admissions. We propose alternative policies for improvement of intermediate care and estimate the effects on the waiting times, hospitalization, and the number of patient replacements. Design: Simulation study. Setting and Participants: For our case study, data were used of older adults who received intermediate care in Amsterdam, the Netherlands, in 2019. For this target group, in- and outflows and patient characteristics were identified. Methods: A process map of the main pathways into and out of the intermediate care was obtained and a discrete event simulation (DES) was built. We demonstrate the use of our DES for intermediate care by evaluating possible policy changes for a real-life case study in Amsterdam. Results: By means of a sensitivity analysis with the DES, we show that in Amsterdam the waiting times are not a result of a lack in bed capacity but are due to an inefficient triage and application process. Older adults have to wait a median of 1.8 days for admission, leading to hospitalization. If the application process becomes more efficient and evening and weekend admissions are allowed, we find that unwanted hospitalization can be decreased substantially. Conclusion and Implications: In this study, a simulation model is developed for intermediate care that can serve as a basis for policy decisions. Our case study shows that the waiting times for health care facilities are not always solved by increasing bed capacity. This underlines the necessity for a data-driven approach to identify logistic bottlenecks and find the best ways to solve them.
AB - Objective: The current waiting times for intermediate care in the Netherlands prohibit timely access, leading to unwanted and costly hospital admissions. We propose alternative policies for improvement of intermediate care and estimate the effects on the waiting times, hospitalization, and the number of patient replacements. Design: Simulation study. Setting and Participants: For our case study, data were used of older adults who received intermediate care in Amsterdam, the Netherlands, in 2019. For this target group, in- and outflows and patient characteristics were identified. Methods: A process map of the main pathways into and out of the intermediate care was obtained and a discrete event simulation (DES) was built. We demonstrate the use of our DES for intermediate care by evaluating possible policy changes for a real-life case study in Amsterdam. Results: By means of a sensitivity analysis with the DES, we show that in Amsterdam the waiting times are not a result of a lack in bed capacity but are due to an inefficient triage and application process. Older adults have to wait a median of 1.8 days for admission, leading to hospitalization. If the application process becomes more efficient and evening and weekend admissions are allowed, we find that unwanted hospitalization can be decreased substantially. Conclusion and Implications: In this study, a simulation model is developed for intermediate care that can serve as a basis for policy decisions. Our case study shows that the waiting times for health care facilities are not always solved by increasing bed capacity. This underlines the necessity for a data-driven approach to identify logistic bottlenecks and find the best ways to solve them.
KW - Intermediate care
KW - health care management
KW - post-acute care
KW - simulation
UR - http://www.scopus.com/inward/record.url?scp=85162104485&partnerID=8YFLogxK
U2 - https://doi.org/10.1016/j.jamda.2023.04.026
DO - https://doi.org/10.1016/j.jamda.2023.04.026
M3 - Article
C2 - 37290484
SN - 1525-8610
VL - 24
SP - 945-950.e4
JO - Journal of the American Medical Directors Association
JF - Journal of the American Medical Directors Association
IS - 7
ER -