Do home and intermediate care work better together? A population-based cost-impact model

Background/Issue

Intermediate care (community hospitals, i.e., OSCO) and home care (ADI) are often planned separately, despite targeting similar frail populations. Evidence on their combined impact on hospital utilization and costs is limited. Accordingly, we assessed whether these services act as complementary strategies in reducing avoidable hospitalization.

Methods

We analyzed data retrieved from regional administrative databases using a multilevel negative binomial model. The primary outcome was hospital bed-days. Key predictors were OSCO availability (beds per population) and ADI intensity, including an interaction term (OSCO×ADI). Models adjusted for demographics, multimorbidity, and clinical conditions, with district-level random effects. Scenario analyses estimated changes in bed-days (ΔLOS) and costs (ΔCost) under different service configurations.

Results

ADI intensity showed a non-linear association with hospital bed-days, with stronger effects at higher levels. OSCO availability alone had no significant impact. However, the interaction term was significant (IRR=0.91; p = 0.026), indicating that the effect of ADI increases with greater OSCO availability. In high-risk subgroups (e.g. dementia, neurodegenerative diseases), combined strategies were associated with up to 20–30% reductions in hospital bed-days. Scenario analyses showed that integrated intermediate and home care configurations produced the largest reductions and generated net cost savings, driven by avoided hospitalizations, with marked heterogeneity across districts.

Conclusions/Lessons

OSCO and ADI should be planned as complementary components of an integrated care pathway. Their combined effect exceeds the impact of each service alone. This modelling approach supports decision-makers in identifying optimal service configurations, prioritizing high-impact districts, and improving efficiency and sustainability of care for chronic and frail populations.

Key messages

• Investing in home care produces greater reductions in hospital use when intermediate care capacity is available: the two services reinforce each other rather than substituting one for the other.

• Combining home and intermediate care generates net cost savings by reducing avoidable hospitalisations, but benefits vary widely across local contexts, supporting the need for district‑level planning.