Potential interactions of community-based acute care teams on the frequency of acute contacts with health-care systems: an interrupted time series analysis

Background: Ageing populations necessitate innovative approaches to health-care services. In 2018, Denmark introduced statutory municipal acute nursing care as part of community-based health care to improve care for adults with complex health needs. We evaluated the potential interactions of the acute care team Odense (ATO) on (1) acute hospital contacts; (2) acute hospital contacts caused by specific infection diagnoses, hypernatraemia, delirium, or confusion; and (3) acute ambulance transports. Methods: In this retrospective, population-based, longitudinal study, we employed interrupted time series analysis to evaluate the association of ATO on adults in Odense Municipality from Jan 1, 2015, to Feb 28, 2019. Subgroup analyses were used to examine the data of people aged 80 years or older, nursing home residents, and people living at home with home or nursing care. Findings: The people treated by ATO were older, had more comorbidities, and were more dependent on municipal health care than the average population. The implementation of ATO was not statistically significantly associated with the monthly rate of acute hospital contacts but associated with a substantial reduction of the monthly rates of acute hospital contacts caused by specific infection diagnoses, hypernatraemia, delirium, or confusion (−2·8 [95% CI −5·5 to −0·1]), and acute ambulance transports (−9·5 [−16·2 to −2·9]). For nursing home residents, the monthly rates decreased for acute hospital contacts caused by specific infection diagnoses, hypernatraemia, delirium, or confusion (−0·8 [−1·7 to 0·0]), and acute ambulance transports (−2·1 [−3·7 to −0·4]). Among those aged 80 years or older, acute ambulance transports decreased monthly (−3·8 [−6·6 to −0·9]). Interpretation: This framework shows potential in minimising transitions between sectors, particularly in the context of acute ambulance transports and acute hospital contacts caused by specific infection diagnoses, hypernatraemia, delirium, or confusion. These findings could offer valuable insights for policy makers on the role of municipal acute nursing care. According to acute hospital contacts, a proportion of numbers might fall beyond the scope of what this framework can prevent, making it valuable to focus on specific groups. Funding: Østifterne, Region of Southern Denmark, Odense University Hospital, and Odense Municipality.