Impact of integrated care on trends in the rate of emergency department visits among older persons in Stockholm County: an interrupted time series analysis

Abstract

OBJECTIVE: To investigate the association between the implementation of an integrated care (IC) system in Norrtälje municipality and changes in trends of the rate of emergency department (ED) visits. DESIGN: Interrupted time series analysis from 2000 to 2015. SETTING: Stockholm County. PARTICIPANTS: All inhabitants 65+ years in Stockholm County on 31 December of each study year. INTERVENTION: IC was established by combining the funding, administration and delivery of health and social care for older persons in Norrtälje municipality, within Stockholm County. OUTCOME: Rates of hospital-based ED visits. RESULTS: IC was associated with a decrease in the rate of ED visits (incidence rate ratio: 0.997, 95% CI 0.995 to 0.998) among inhabitants 65+ years in Norrtälje. However, the rate of ED visits remained higher in Norrtälje than the rest of Stockholm in the preintervention and postintervention periods. Stratified analyses showed that IC was associated with a decline in the trend of the rate of ED visits among those 65-79 years, the lowest income group and born outside of Sweden. However, there was no significant decrease in the trend among those 80+ years. CONCLUSION: The implementation of IC was associated with a modest change in the trend of ED visits in Norrtälje, though the rate of ED visits remained higher than in the rest of Stockholm. Changes in the composition of the population and contextual changes may have impacted our findings. Further research, using other outcome measures is needed to assess the impact of IC on healthcare utilisation.