Mobile Integrated Health and Hospital Utilization for Congestive Heart Failure in a Rural Setting

Abstract

Background: Heart failure is a leading cause of hospitalization with a high readmission rate. Mobile integrated health care (MIH) programs have expanded the role of emergency medical services to provide community-based care to patients with chronic disease, such as heart failure. However, there is little data published on the outcomes of MIH programs.

Objective: This study evaluated the effect of a rural MIH program on emergency department and inpatient utilization for patients with congestive heart failure.

Methods: A retrospective propensity score matched case-control study patients was performed for patients who participated in the MIH program associated with a single rural Pennsylvania health system between April 2014 and June 2020. Cases and controls were matched based on demographics and comorbidities. Pre- and post-intervention utilization were examined at 30, 90, and 180 days from the index encounters within the treatment groups, and then compared to the change in utilization among controls.

Results: 1237 patients were analyzed. The change in all-cause ED utilization among cases was significantly better than the change in ED utilization among controls at 30 (Δ = -3.6%; 95% CI: −6.1%, −1.1%) and 90 days (Δ = -3.5%; 95% CI: −6.7%, −0.2%). There was no significant change in all-cause inpatient utilization at 30, 90, or 180 days. Limiting to CHF-only encounters also showed no significant change in utilization between cases and controls at any of the time intervals.

Conclusion: Analysis of this MIH program demonstrates efficacy in delivering community-based care to reduce all-cause ED utilization. Prospective studies should be conducted to better assess the effects on inpatient utilization, cost data, and patient satisfaction to evaluate the effectiveness of such programs more holistically.

Disclosure statement

The authors have no conflicts of interest to declare.

IRB approval

This study received exempt approval through the Geisinger institutional review board.

Authorship statement

All authors contributed to the design and implementation of the research, to the analysis of the results, and to the writing of the manuscript.