Hostname: page-component-cd9895bd7-8ctnn Total loading time: 0 Render date: 2024-12-26T20:29:03.531Z Has data issue: false hasContentIssue false
  • English
  • Français

The Efficacy and Efficiency of the Quick Response Program: A Randomized Controlled Trial

Published online by Cambridge University Press:  29 November 2010

Robin Weir ,
Gina Browne ,
Carolyn Byrne ,
Jacqueline Roberts ,
Amiram Gafni ,
Arlene Thompson ,
Marian Walsh  and
Lynda McColl
Robin Weir
Affiliation:
McMaster University
Gina Browne
Affiliation:
McMaster University
Carolyn Byrne
Affiliation:
McMaster University
Jacqueline Roberts
Affiliation:
McMaster University
Amiram Gafni
Affiliation:
McMaster University
Arlene Thompson
Affiliation:
McMaster University
Marian Walsh
Affiliation:
Home Care Program, Toronto
Lynda McColl
Affiliation:
Etobicoke General Hospital
Get access Rights & Permissions [Opens in a new window]

Abstract

Quick Response Programs (QRP) have been instituted to contain hospital costs by reducing unnecessary hospital admissions through the prompt co-ordination of Home Care Services. No formal economic evaluation of the impact of this redirection of services has been conducted. This paper describes a randomized controlled trial designed to compare the costs and effects between comparable emergency department patients (ED) serviced by the QRP versus the usual department services. Patients were assessed at baseline and 10 days following discharge from the ED specifically for their health status, caregiver burden, satisfaction with health care services and expenditures. QRP was an acceptable alternative to ED services for a small percentage of patients and was not more expensive in total care costs although there was a shift in expenditures from hospital to Home Care services. Due to the small sample size the power to detect the clinically important differences in health status was 60 per cent.

Résumé

Les programmes d'intervention rapide ont été institués dans le but d'amoindrir les coûts des centres hospitaliers en diminuant le nombre d'admissions non nécessaires dans ces établissements grâce à la prompte coordination de soins à domicile. Aucune évaluation économique formelle de l'impact de cette réorientation des services n'a été réalisée. Ce document expose un essai contrôlé qui a été réalisé dans le but de comparer les coûts et les conséquences entre des patients comparables du service des urgences soignés selon le programme d'intervention rapide par rapport aux services de départements habituels. Les patients ont été évalués au moment de leur admission et dix jours après avoir reçu leur congé de l'urgence spécifiquement pour leur état de santé, pour la charge du dispensateur de soins, pour la satisfaction des soins reçus et pour les coûts. Le programme d'intervention rapide s'est avéré un choix acceptable par rapport aux services de l'urgence pour un faible pourcentage de patients et ne s'est pas avéré plus cher pour l'ensemble des coûts bien qu'il y ait eu un réacheminement des dépenses de l'hôpital vers les soins à domicile. À cause de l'échantillonnage restreint, la capacité de détecter les différences importantes dans l'état de santé, sur le plan clinique, s'est établie à 60 pour cent.

Keywords

Quick Response ProgramRandomized Controlled TrialEffectivenessEfficiencyLes programmes d'intervention rapideétude sur échantillon aléatoire et contrôléefficacité
Type
Articles
Information
Canadian Journal on Aging / La Revue canadienne du vieillissement , Volume 17 , Issue 3 , Automne/Fall 1998 , pp. 272 - 295
Copyright
Copyright © Canadian Association on Gerontology 1998

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Attkisson, CC, & Zwick, E. (1982). The client satisfaction questionnaire: Psychometric properties and correlations with service utilization and psychotherapy outcome. Evaluation and Program Planning, 5, 233–237.CrossRefGoogle ScholarPubMed
Barrett, B., & Neville, D. (1991). Study to determine feasibility of QRT service and development of randomized trial comparing QRT services to existing care. St. John's, Nfld. tripartite Liaison Committee of St. John's Hospital Council, St. John's Nursing Home Council and St. John's Home Care Program.Google Scholar
Barrett, B., & Neville, D. (1994). A randomized clinical trial to evaluate the impact of a quick response team for patients presenting to hospital emergency departments. NHRDP #6601–1204–301.Google Scholar
Boyak, U.J., & Bucknam, A.E. (1991). The quick response team: A pilot project. Social Work in Health Care, 16, 55–68.CrossRefGoogle Scholar
Browne, G., Roberts, J., Gafni, A., Weir, R., Watt, S., & Byrne, C. (1995). More effective and less expensive: Lessons from five studies examining community approaches to care. Health Policy, 34, 95–112.CrossRefGoogle ScholarPubMed
Cameron, S., Rajacich, D., & Charett, M. (1994). Evaluation of the Quick Response Program in Windsor/Essex county. Final Report Ministry of Health.Google Scholar
Clarke, A. (1996). Why are we trying to reduce length of stay? Evaluation of the costs and benefits of reducing time in hospital must start from the objectives that govern the change. Quality in Health Care, 6, 172–179.CrossRefGoogle Scholar
Coughlin, T.A., McBride, T.D., Perozek, M., & Liu, K. (1992). Home care for the disabled elderly: Predictions and expected costs. Health Services Research, 27(4), 453–479.Google Scholar
Darby, P. (1992). Quick response teams: A new approach in utilization management leadership. September/October, 27–31.Google Scholar
Dawson, J.T., & Critchley, L. (1992). Community-hospital partnerships: The quick response team. JONA, 22, 33–39.Google ScholarPubMed
Feinstein, A. (1977). Clinical biostatistics. Saint Louis: The C. Mosby Company.CrossRefGoogle ScholarPubMed
Humber Memorial Hospital. (1995). Report of the quick response program pilot project involving the home care programs for Metropolitan Toronto, Etobi coke General and Humber Memorial Hospitals. Unpublished Report. Toronto, Ontario, May.Google Scholar
LeBourdais, E. (1991). “SWAT Team” helps Victoria solve problems caused by geriatric “bedblockers”. Canadian Medical Association Journal, 145, 1493–1495.Google ScholarPubMed
McHorney, C.A., Ware, J.E., Rogers, W., Raczek, A., & Rachel, J. (1992). The validity and relative precision of MOS short and long form health status scales and Dartmouth COOP charts: Results from the medical outcomes study. Medical Care, 30(Supp. 5), 253–265.CrossRefGoogle Scholar
Turk, D.C., Rudy, T.K., & Steig, R.L. (1988). The disability determination dilemma: Toward a multiaxial solution. Pain, 34, 217–229.CrossRefGoogle Scholar
Ware, J., Kosinski, M., Bayliss, M., McHorney, C., Rogers, W., & Raczek, A. (1995). Comparison of methods for the scoring and statistical analysis of SF–36 health profile and summary measures: Summary results from the medical outcomes study. Medical Care, 33(4), AS264–AS279.Google Scholar
Ware, J., Kosinski, M., & Keller, S. (1994). SF–36 physical and mental health summary scales: A user's manual. Boston: The Health Institute, New England Medical Centre.Google Scholar
Ware, J., & Sherbourne, C. (1992). The MOS 36-item short form health survey (SF–36). Medical Care, 30(6), 473–481.CrossRefGoogle ScholarPubMed
Ware, J.E., Snow, K, Kosinski, M., & Gandek, B. (1993). SF–36 health survey. Manual and interpretation guide. The Health Institute, New England Medical Centre. Boston, MA: Nimrod Press.Google Scholar
Weir, E., Browne, G., Byrne, C., Roberts, J., Gafni, A., Thompson, A., Walsh, M., & McColl, L. (1996). The quick response program involving the home care program, Metropolitan Toronto and the Humber Memorial and Etobicoke General Hospitals: The need, acceptability, capacity, safety, effects and expense from hospital and home care points of view. Final Report, June.Google Scholar
Weir, R., Browne, G., Byrne, C., Roberts, J., Gafni, A., Thompson, A., Walsh, M., & McColl, L. (1997). Dealing with the pressure at the emergency room: The quick response initiative. Unpublished manuscript, December.Google Scholar
Wilkin, D., Hallan, L., & Doggett, M. (1992). Measures of need and outcome for primary health care. Oxford: Oxford University Press.Google Scholar
Zarit, S.H., Todd, P.A., & Zarit, J.M. (1986). Subjective burden of husbands and wives as caregivers: A longitudinal study. Gerontologist, 26(3), 260–266.CrossRefGoogle ScholarPubMed