Figure 1
Flow diagram of the study population and allocation into Case and Control Groups.
Table 1
Comparison of characteristics of cases and controls.
| CASES n = 4381 | CONTROLS n = 13143 | P-VALUEa | |
|---|---|---|---|
| Sex, n (%) | 1 | ||
| Men | 1468 (33.5) | 4404 (33.5) | |
| Women | 2913 (66.5) | 8739 (66.5) | |
| Dependency degree, n (%) | 1 | ||
| I | 2734 (62.0) | 8202 (62.4) | |
| II | 1226 (28.0) | 3678 (28.0) | |
| III | 421 (9.61) | 1263 (9.61) | |
| Age (years) | <0.001 | ||
| Mean (SD) | 79.4 (14.2) | 79.7 (13.8) | |
| Median (IQR) | 83 (76–87) | 83 (77–87) | |
| Income level, n (%) | 0.511 | ||
| High | 2 (0.05) | 0 (0.00) | |
| Medium | 497 (11.3) | 1.485 (11.3) | |
| Low | 3622 (82.7) | 10 891 (82.9) | |
| Very low | 260 (5.93) | 767 (5.84) | |
| GMA index | <0.001 | ||
| Mean (SD) | 27.1 (14.3) | 27.0 (13.9) | |
| Median (IQR) | 24.4 (16.7–35.3) | 24.4 (16.7–35.0) | |
| GMA stratification, n (%) | 0.276 | ||
| Baseline risk | 24 (0.55) | 58 (0.44) | |
| Low risk | 227 (5.18) | 633 (4.82) | |
| Moderate risk | 1631 (37.2) | 4998 (38.0) | |
| High risk | 2499 (57.0) | 7454 (56.7) | |
| Delivery of social home care, n (%) | <0.001 | ||
| Service | 3564 (81.4) | 10 158 (77.3) | |
| Economic allowance | 817 (18.6) | 2985 (22.7) | |
| Kind of municipality, n (%) | <0.001 | ||
| Urban | 3702 (84.5) | 11 128 (84.7) | |
| Semi-rural | 394 (8.99) | 1167 (8.88) | |
| Rural | 285 (6.51) | 848 (6.45) | |
| Healthcare expenditure in the previous year (Euros/person/year) | <0.001 | ||
| Mean (SD) | 5545 (7871) | 5369 (7414) | |
| Median (IQR) | 3112 (1482–6593) | 3062 (1509–6292) |
[i] IQR, interquartile range; GMA, Adjusted Morbidity Groups; SD, standard deviation.
aMcNemar and Wilcoxon paired-data.
Figure 2
Probability of (A) survival and (B) institutionalization up to 2 years after initiation of social HCSs of cases and controls (2018–2019 period).
Table 2
Changes in the utilization of social services by cases and controls during the year before and after home care services initiation (2018–2019 period).
| CONTROLS | CASES | DOUBLE DIFFERENCE | RATIOa | 95% CI | |||||
|---|---|---|---|---|---|---|---|---|---|
| BEFORE | AFTER | CHANGE | BEFORE | AFTER | CHANGE | ||||
| Social HCSs | |||||||||
| Personal care (hours/person/month), mean | 0 | 17.9 | 17.9 | 0 | 17.7 | 17.7 | –0.2 | 1.012 | 0.959–1.066 |
| Household (hours/person/month), mean | 0 | 2.4 | 2.4 | 0 | 2.7 | 2.7 | 0.3 | 1.050 | 1.018–1.081 |
| Household, % | 0 | 32.1 | 32.1 | 0 | 36.6 | 36.6 | 4.5 | 1.382 | 1.337–1.428 |
| Other social services, % | |||||||||
| Non-professional caregiver allowance | 18.4 | 13.3 | –5.1 | 22.8 | 14.9 | –7.9 | –2.8 | 0.734 | 0.658–0.819 |
| Telecare | 2.9 | 38.6 | 35.7 | 3.1 | 38.7 | 35.6 | –0.1 | 0.933 | 0.822–1.058 |
| Day center | 2.2 | 3.6 | 1.4 | 2.2 | 4.2 | 2 | 0.6 | 1.237 | 1.016–1.506 |
[i] CI, Confidence interval; HCSs, home care services.
aAdjusted by sex, age, dependency level, income level, morbidity, and previous kind of service and healthcare expenditure.
Figure 3
Impact of the integration of social and health home care services on the utilization of social services. A ratio of relative risks adjusted by age, sex, dependency level, income level, morbidity and previous kind of services and healthcare expenditures is presented (2018–2019 period). The reference rate (set at 1) was that of controls before social HCS initiation. The lines across each box represent the ratio of changes in utilization rates before and after social HCS initiation between cases and controls, and the blue boxes represent the 95% confidence interval. The dashed line at 1.0 indicates no change and the blue boxes above and below the line indicate significantly increased and decreased utilization between groups, respectively.
Table 3
Changes in the utilization of healthcare services by cases and controls before and after social HCS initiation (2018–2019 period). Monthly rates per 100 individuals.
| CONTROLS | CASES | DOUBLE DIFFERENCE | RATIOa | 95% CI | |||||
|---|---|---|---|---|---|---|---|---|---|
| BEFORE | AFTER | CHANGE | BEFORE | AFTER | CHANGE | ||||
| Overall visits to primary care services | 211.3 | 217.7 | 6.4 | 206.0 | 219.2 | 13.2 | 6.8 | 1.030 | 1.012–1.050 |
| Primary healthcare professional | |||||||||
| Physician visits | 105.8 | 105.3 | –0.6 | 100.5 | 103.5 | 3.0 | 3.6 | 1.034 | 1.007–1.061 |
| Nurse visits | 91.7 | 101.5 | 9.8 | 91.1 | 104.6 | 13.4 | 3.6 | 1.034 | 1.006–1.063 |
| Social worker visits | 13.8 | 10.9 | –2.8 | 14.4 | 11.1 | –3.3 | –0.4 | 0.971 | 0.899–1.049 |
| Location of visits | |||||||||
| Primary care center | 126.9 | 122.4 | –4.5 | 124.1 | 122.4 | –1.7 | 2.9 | 1.018 | 0.994–1.043 |
| Home | 41.7 | 51.9 | 10.2 | 39.7 | 52.3 | 12.6 | 2.3 | 1.062 | 1.020–1.105 |
| Remote | 42.7 | 43.4 | 0.7 | 42.2 | 44.5 | 2.3 | 1.6 | 1.035 | 0.993–1.079 |
| Hospitalizations | 5.4 | 5.7 | 0.3 | 6.0 | 6.7 | 0.7 | 0.4 | 1.048 | 0.936–1.172 |
| Emergency hospitalizations | 3.8 | 4.3 | 0.5 | 4.2 | 5.4 | 1.2 | 0.7 | 1.122 | 0.986–1.277 |
| Visits to emergency services | 15.4 | 15.9 | 0.5 | 16.2 | 17.7 | 1.5 | 1.0 | 1.047 | 0.977–1.121 |
| Outpatient consultations | 38.3 | 32.2 | –6.0 | 40.7 | 35.9 | –4.8 | 1.2 | 1.040 | 0.994–1.087 |
| Medications | 830.9 | 837.4 | 6.5 | 838.1 | 843.5 | 5.5 | –1.0 | 0.994 | 0.984–1.003 |
| Non-emergency transportation | 42.7 | 39.5 | –3.3 | 42.7 | 38.0 | –4.7 | –1.4 | 0.945 | 0.906–0.985 |
| Intermediate care center admissions (days) | 79.0 | 55.9 | –23.1 | 81.6 | 56.6 | –25.0 | –1.9 | 0.977 | 0.945–1.011 |
| Total duration of hospitalization/institutionalizationb (days) | 119.3 | 144.8 | 25.5 | 121.5 | 137.7 | 16.1 | –9.3 | 0.923 | 0.905–0.943 |
[i] CI, confidence Interval; HCSs, home care services.
aAdjusted by sex, age, dependency level, income level, morbidity, and previous kind of service and healthcare expenditure.
bHospitalizations and institutionalizations in any health or social care center, including acute care, mental health, intermediate care, and institutionalization centers, are considered.
Figure 4
Impact of the integration of social and health home care services on the utilization of healthcare services. A ratio of relative risks adjusted by age, sex, dependency level, income level, morbidity, and previous kind of services and healthcare expenditures is presented (2018–2019 period). The reference rate (set at 1) was that of controls before social HCS initiation. The lines across each box represent the ratio of changes in utilization rates before and after social HCS initiation between cases and controls, and the blue boxes represent the 95% confidence interval. The dashed line at 1.0 indicates no change, and the blue boxes above and below the line indicate significantly increased and decreased utilization between groups, respectively.
Table 4
Changes in expenditures associated with social and healthcare services utilization in cases and controls before and after social HCS initiation (Euros/person/month).
| CONTROLS | CASES | DOUBLE DIFFERENCE | COEFICIENTDIFFERENCEa | 95% CI | |||||
|---|---|---|---|---|---|---|---|---|---|
| BEFORE | AFTER | CHANGE | BEFORE | AFTER | CHANGE | ||||
| Healthcare-associated expenditures | |||||||||
| Outpatient | 112.4 | 112.4 | 0.0 | 111.1 | 113.3 | 2.2 | 2.2 | 0.039 | –0.013–0.090 |
| Hospitalizations | 200.3 | 186.0 | –14.3 | 229.4 | 209.5 | –19.9 | –5.6 | –0.008 | –0.063–0.046 |
| Mediations | 124.5 | 126.2 | 1.6 | 127.0 | 131.3 | 4.3 | 2.6 | –0.006 | –0.049–0.037 |
| Other | 46.9 | 48.4 | 1.5 | 41.2 | 40.8 | –0.3 | –1.9 | 0.001 | –0.037–0.039 |
| Total healthcare-associated expenditures | 484.1 | 477.1 | –7.1 | 508.6 | 496.9 | –11.7 | –4.7 | –0.002 | –0.039–0.035 |
| Social care-associated expenditures | |||||||||
| Home care services Dependency | 0.0 | 326.4 | 326.4 | 0.0 | 329.5 | 329.5 | 3.2 | 0.286 | 0.219–0.353 |
| Telecare | 0.4 | 5.0 | 4.6 | 0.4 | 5.0 | 4.6 | 0.0 | –0.001 | –0.023–0.021 |
| Non-professional caregiver | 47.0 | 38.3 | –8.6 | 56.4 | 42.7 | –13.8 | –5.1 | –0.135 | –0.175 – –0.095 |
| Institutionalization | 4.9 | 28.9 | 24.0 | 2.3 | 20.8 | 18.5 | –5.5 | –0.029 | –0.046 – –0.011 |
| Day center | 6.6 | 10.4 | 3.8 | 6.5 | 11.7 | 5.2 | 1.4 | 0.032 | 0.009–0.054 |
| Total social care-associated expenditures | 59.0 | 394.0 | 334.9 | 66.0 | 395.8 | 329.8 | –5.2 | –0.191 | –0.230 – –0.152 |
| Total expenditures (healthcare and social) | 543.1 | 871.0 | 327.9 | 574.7 | 892.7 | 318.1 | –9.8 | –0.026 | –0.054–0.002 |
[i] CI, confidence interval.
aAdjusted by sex, age, dependency level, income level, morbidity, and previous kind of service and healthcare expenditure.
Figure 5
Impact of the integration of social and health home care services on changes in social and healthcare-associated expenditures. The difference of coefficients, adjusted by age, sex, dependency level, income level, morbidity, and previous kind of services and healthcare expenditures is presented (2018–2019 period). The reference expenditure (set at 0) was that of controls before social HCS initiation. The lines across the boxes represent the differences in coefficients of expenses before and after social HCS initiation between cases and controls, and the blue boxes represent the 95% confidence interval. The dashed line at 1.0 indicates no change, and the blue boxes above and below the line indicate significantly increased and decreased expenses between groups, respectively.