Identifying patient-level health and social care costs for older adults discharged from acute medical units in England

BACKGROUND: acute medical units allow for those who need admission to be correctly identified, and for those who could be managed in ambulatory settings to be discharged. However, re-admission rates for older people following discharge from acute medical units are high and may be associated with substantial health and social care costs.

OBJECTIVE: identifying patient-level health and social care costs for older people discharged from acute medical units in England.

DESIGN: a prospective cohort study of health and social care resource use.

SETTING: an acute medical unit in Nottingham, England.

PARTICIPANTS: four hundred and fifty-six people aged over 70 who were discharged from an acute medical unit within 72 h of admission.

METHODS: hospitalisation and social care data were collected for 3 months post-recruitment. In Nottingham, further approvals were gained to obtain data from general practices, ambulance services, intermediate care and mental healthcare. Resource use was combined with national unit costs.

RESULTS: costs from all sectors were available for 250 participants. The mean (95% CI, median, range) total cost was £1926 (1579-2383, 659, 0-23,612). Contribution was: secondary care (76.1%), primary care (10.9%), ambulance service (0.7%), intermediate care (0.2%), mental healthcare (2.1%) and social care (10.0%). The costliest 10% of participants accounted for 50% of the cost.

CONCLUSIONS: this study highlights the costs accrued by older people discharged from acute medical units (AMUs): they are mainly (76%) in secondary care and half of all costs were incurred by a minority of participants (10%).