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Mobile Home Care for Elderly Saved Millions of Dollars in Sweden

Rationale / Objectives

There are significant numbers of older patients in Sweden visiting emergency rooms without having life-threatening conditions that could be cared for in alternative settings (including home). In addition, diverting such patients will reduce emergency department visits and associated long wait times.

Project/Program Description & Major Achievements

Funded by The Swedish Association of Local Authorities and Regions, the Mobile Emergency Team was implemented in 2011 as a pilot project and later became a permanent unit aiming to deliver urgent home care for the elderly population in Uppsala, Sweden. The team consists of a nurse and a doctor who advise municipal nurses and visit patients in their homes. The target patients for this team are people over the age of 65 needing urgent care. Patients are able to reach the Mobile Team through both municipal nurses and through the healthcare information line. Ambulance personnel and nursing home staff have the ability to call on the Mobile Team. The project successfully saved the county millions annually.

Lessons Learned

After 5 years running, the cost-saving value of the Mobile Team has been significant along with increases in patient satisfaction. However, as the care needs continue to rise, the team is advised to widen it's range of services. Moreover, follow-up visits at home after the primary visits are necessary for patient check-ups. More specialists are also necessary to increase access for patients, since only 1% of the Mobile Team’s patients can access referral to a geriatric specialist.

People / Organizations Involved

Further Description

In Sweden, the nation is organized into municipalities. Each county has several municipalities which are responsible for care for the elderly. The Uppsala County has eight municipalities, including the Uppsala municipality. Uppsala University Hospital (Uppsala County) has an emergency room, and is the only county hospital financed by county taxes. Thus, fewer visits to the emergency room translates into less cost for the county.2 The Mobile Emergency Team (Mobile Team) began in Uppsala, Sweden as a pilot project in September 2011 and later in 2014 became a permanent unit. Mobile Team aims to deliver urgent home care for elderly persons. The long-term goal is for the team to “create integrated structures of healthcare and social care in Uppsala Municipality”.2 The Mobile Team includes a nurse coming from the municipality and a doctor from the county in addition to other key healthcare providers. The team’s duties include advising municipal nurses and providing home care for patients, in addition to the provision of ambulance services, Uppsala University Hospital, the telephone healthcare advisory line, primary healthcare clinics, municipal nurses in home healthcare teams, and homecare organization. Since Mobile Team was implemented, the number of ED visits has reduced significantly. 40% of the costs to run the Mobile Team are covered by the Uppsala Municipality and the Uppsala County pays for the remaining 60%. During 2014, the total cost to run the Mobile Team was $416,670 US dollars. 

Major Achievements

The Mobile team became a permanent unit in January 2014. Patient questionnaires over the course of the pilot study indicated that the majority of patients felt satisfied with the Mobile Team. The mobile team was able to effectively refer patients to the proper resources after their assessment. The Mobile team referred 18% of patients to the Emergency Department at Uppsala University Hospital and 85% of those patients were admitted to the hospital.1% of patients were sent directly to a geriatric ward after their assessment. An estimated 460 patients were saved a trip to the Uppsala University Hospital.

Metric

Result

Detail

Dropout rate

decreased by 60%

*between 2014 and 2015 as a result of program improvements based on patient feedback

Number of patients treated per day ~6 people 80% of these patients were treated at home. 
Reduction in costs from Mobile Team 9 million swedish kronor anually *equivalent of $1.2 million US dollars