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%).
Keywords: acute medical unit; costing methodology; economic evaluation; primary care; secondary care; social care.
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