Outcomes of a geriatric emergency medicine care transition program, SCOUTS (Supporting Community, Outpatient, Urgent Care, and Telehealth Services)

BACKGROUND: Ensuring follow up care can be a barrier to emergency department (ED) discharge for high-risk older adults. The US Dept of Veterans Affairs (VA) sought to address this challenge by creating an ED-based care transition program, SCOUTS (Supporting Community, Outpatient, Urgent care, and Telehealth Services). SCOUTS combines post ED care coordination and a home visit to assess home safety, geriatric syndromes, and unmet social needs and to provide a video visit with an ED provider. The purpose of this study is to evaluate the effects of the program on health care utilization. 

METHODS: Patients (aged ≥ 65 years) identified as high risk through geriatric emergency medicine care processes were offered a home visit with the program. SCOUTS patients were compared to a 1:1 propensity matched group of older ED patients. Primary outcomes for health care utilization included hospital admissions (from ED and 30- and 90-days after ED visit) and ED revisits (3 days and 30 days). 

RESULTS: During the first year of the program, there were 684 SCOUTS patients matched to 684 ED patients. SCOUTS patients were less likely to be admitted to the hospital from the ED (OR 0.12 (95% CI 0.07-0.02)) and had lower 30- and 90-day inpatient admissions (OR 0.33 (CI 0.24-0.45), OR 0.48 (CI 0.37-0.63)). Secondary matching of only discharged patients showed a decrease in 72-h ED revisit (OR 0.29 (CI 0.15, 0.6)), while maintaining an equivalent 30-day ED revisit rate and 30- and 90-day admissions as matched control. SCOUTS patients were significantly more likely to receive durable medical equipment orders (OR 1.94 (CI 1.54, 2.45)) and follow up with VA social work (OR 1.41 (CI 1.02, 1.95)). 

CONCLUSIONS: An ED-based care transition program using home visits decreases admissions and ED revisits while increasing orders for durable medical equipment and referrals to follow up services.