Sara Campagna - Department of Public Health and Paediatrics, Università di Torino, Torino, Italy
Alberto Borraccino - Department of Public Health and Paediatrics, Università di Torino, Torino, Italy
Gianfranco Politano - Department of Control and Computer Engineering, Politecnico di Torino, Torino, Italy
Alfredo Benso - Department of Control and Computer Engineering, Politecnico di Torino, Torino, Italy
Marco Dalmasso - Epidemiology Unit, Local Health Unit TO۳, Grugliasco (TO), Piedmont, Italy
Valerio Dimonte - Department of Public Health and Paediatrics, Università di Torino, Torino, Italy
Maria Michela Gianino - Department of Public Health and Paediatrics, Università di Torino, Torino, Italy

BackgroundAllowing patients to remain at home and decreasing the number of unnecessary emergency room visits have become important policy goals in modern healthcare systems. However, the lack of available literature makes it critical to identify determinants that could be associated with increased emergency department (ED) visits in patients receiving integrated home care (IHC).MethodsA retrospective observational study was carried out in a large Italian region among patients with at least one IHC event between January ۱, ۲۰۱۲ and December ۳۱, ۲۰۱۷. IHC is administered from ۸ am to ۸ pm by a team of physicians, nurses, and other professionals as needed based on the patient’s health conditions. A clinical record is opened at the time a patient is enrolled in IHC and closed after the last service is provided. Every such clinical record was defined as an IHC event, and only ED visits that occurred during IHC events were considered. Sociodemographic, clinical and IHC variables were collected. A multivariate, stepwise logistic analysis was then performed, using likelihood of ED visit as a dependent variable.ResultsA total of ۲۹ ۲۰۹ ED visits were recorded during the ۶۶ ۴۳۳ IHC events that took place during the observation period. There was an increased risk of ED visits in males (odds ratio [OR] = ۱.۲۹), younger patients, those with a family caregiver (OR = ۱.۱۳), and those with a higher number of cohabitant family members. Long travel distance from patients’ residence to the ED reduced the risk of ED visits. The risk of ED visits was higher when patients were referred to IHC by hospitals or residential facilities, compared to referrals by general practitioners. IHC events involving patients with neoplasms (OR = ۱.۹۱) showed the highest risk of ED visits.ConclusionEvidence of sociodemographic and clinical determinants of ED visits may offer IHC service providers a useful perspective to implement intervention programmes based on appropriate individual care plans and broad-based client assessment.

Emergency Department Visits, Integrated Home Care, Administrative Health Data, Risk Factors, Retrospective Study Italy, Ethical Issues