Assessment of the effect of home health care services on emergency department admissions in geriatric patients: A cross-sectional observational study

Home healthcare services (HHS) have been increasingly implemented worldwide with the aim of reducing emergency department admissions and healthcare costs, particularly in geriatric populations. This study aimed to evaluate whether HHS impacts hospitalization rates, intensive care unit (ICU) utilization, mortality, 1-year survival, and hospital costs among older adults. This retrospective, cross-sectional observational study was conducted at a tertiary care hospital in Turkey between January 2021 and December 2022. Patients aged ≥ 65 years presenting to the emergency department were included and categorized into 2 groups based on whether they received home healthcare services. Demographic characteristics, comorbidities, ICU and ward length of stay, acute physiology and chronic health evaluation-II scores, 1-year survival, and hospital costs were compared between groups. Data were extracted from the hospital's electronic medical records and analyzed using appropriate statistical methods. A total of 8590 geriatric patients were included; 10.1% (n = 866) received HHS. Patients in the HHS group had significantly higher rates of comorbidities, longer hospital (8.33 ± 7.76 vs 6.99 ± 5.47 days, P < .001) and ICU stays (9.53 ± 14.60 vs 8.08 ± 13.60 days, P = .030), and higher mean hospital costs (12,784 ± 26,308 vs 10,225 ± 20,917 Turkish Lira, P < .001). One-year survival was significantly lower in the HHS group (62.9% vs 68.9%, P < .001). Acute physiology and chronic health evaluation-II scores were also significantly higher among patients receiving HHS (P = .010). HHS in its current structure appears to be delivered predominantly to severely ill geriatric patients and does not lead to reduced hospital utilization or cost savings. To improve clinical and economic outcomes, we recommend restructuring HHS to include earlier patient selection, integration with emergency services, and incorporation of standardized geriatric assessment tools.