De l'innovation au changement - Gouvernement du Québec

5. BILAN DE L’EXPÉRIMENTATION
Projet 11
Dépistage et intervention auprès des personnes âgées obtenant leur congé du service des urgences d’un hôpital et risquant de
subir des conséquences indésirables, région de Montréal
Seniors discharged from hospital emergency departments at risk of adverse outcomes : screening and intervention
5.1 Résultats In 91 patients (61.9%), there was no follow-up by the intervention nurses after the date of the initial assessment. Follow-up among 56
patients mainly comprised telephone calls to the patient, the community health centre, and/or the primary physician; 34 patients had
follow-up for up to one week after the initial assessment; and 22 patients had longer follow-up, ranging up to 2 months.
Referrals for home care or to the primary physician were noted significantly more frequently among intervention vs control group patients.
No differences by study group were found for outpatient clinic or other referrals.
Process of care after ED visit : 1) Primary physician : More intervention than control group patients (27.5% vs 18.6%, p=0.0575) reported
that they contacted their primary physician as a result of advice at the ED visit. 2) Local community health center (CLSC) : The selfreported
contact rate with the CLSC following referral was similar in the two groups: 9.3% of intervention and 11.2% of controls (p=0.571).
3) Return to the ED : A higher proportion of intervention than control group patients returned to the ED during the month after the index
visit, although they returned slightly later than controls.
The intervention significantly reduced the rate of functional decline during the 4 months after the ED visit, from 30.9% to 21.1%. We
hypothesize that this beneficial outcome occurred as a result of 3 improvements in the care of patients: 1) systematic detection in the ED
of problems that may lead to functional decline, and systematic transfer of this information to the primary physician, which led to a more
appropriate or focussed approach; 2) more rapid contact with the primary physician, especially among patients with an ongoing
relationship with this physician; and 3) earlier provision of CLSC services, particularly among patients not previously known to the CLSC.
The changes in depressive symptoms at four months relative to baseline indicated somewhat greater improvement in the intervention vs
the control group, but this was not statistically significant. There was also no significant effect of the intervention on change in patient’s
health-related quality of life at four months relative to baseline.
Caregiver health outcomes (4 months): There was no significant intervention effect on change in caregiver physical or mental health or
quality of life scores from baseline to 4 months for these outcomes
In general, costs in each category and overall were similar in the intervention and control groups. Intervention group patients had higher
mean costs in the following cost categories: intervention nurse, ED visits (hospital component), prescription drugs, and patient and
caregiver out-of pocket costs.
In comparison to usual care, the intervention appears to have improved communication between the hospital ED and the primary
physician. Self-reported contacts with the primary physician in the intervention group were more often related to the ED referral than those
in the control group.
In comparison to usual care, the intervention appears to have increased access to CLSC-provided home care services during the month
after the ED visit. Among both prior CLSC users and non-users, intervention group patients were more likely than controls to receive
services in the home. Among patients not previously known to the CLSC, intervention group patients tended to receive these services
more quickly.
Despite the beneficial effects, the intervention failed to reduce the rate of return visits to the ED. In the first month after the index ED visit,
there was actually an increase in the rate of return to the ED in intervention group patients.
We also failed to find evidence of an intervention effect on the family caregiver’s health status. The lack of such an effect in our study may
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