Life In The Slower Lane

Here is the structured PICO analysis for the second article you uploaded:

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Full Title (verbatim and exact):

“Outreach acute care for nursing homes: an observational study on the quality and cost-effectiveness of the Mobile Hospital”

Kontunen Perttu, Leppänen Roope, Linna Miika, Castrén Maaret, Torkki Paulus

Age and Ageing (2025); 54: afae287

DOI: https://doi.org/10.1093/ageing/afae287

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📄 

Type of Article:

Observational pre–post study with benchmarking-controlled analysis

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🔍 

PICO Analysis:

Population:

• Nursing home residents (n = ~1345 in 2018 and ~1342 in 2019) in Espoo, Finland
• Aged >75 years, with frailty and complex health needs
• Setting: Residential aged care (nursing homes), within a universal healthcare system context
• Benchmarking data included >75 population from 10 largest Finnish cities 

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Intervention:

• Mobile Hospital service (introduced in March 2019):
  • A 24/7 outreach acute care unit staffed by specially trained nurses
  • Responds to acute care consultations from nursing homes
  • Provides on-site treatment including point-of-care (POC) diagnostics, IV therapy, antibiotics, and palliative care
  • Supported by advance care planning and a weekday on-call physician consultation service

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Comparator:

• Pre-intervention period (2018) with standard emergency care (i.e., Emergency Medical Services [EMS] and Emergency Department [ED] attendance)
• Benchmarking control group: 10 other large Finnish cities without the Mobile Hospital model
  • This control group allows for temporal validation against wider national trends in ED and hospital use

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Outcome:

1. Person-centred outcomes:

• ED readmission within 24 hours (stable: 128 → 108)
• Mortality (slight, non-significant increase: 0.8% → 1.4%)These were used to assess safety and appropriateness of outreach care

2. Process outcomes:

• ED visits decreased 22% (801 → 622)
• EMS missions decreased 16% (720 → 604)
• Primary hospital admissions decreased 38% (285 → 178)
• ED throughput time improved (7.79 → 7.00 hours)
• Benchmarked ED visit rates per 100 older persons decreased in Espoo but increased in other cities 

3. Health system outcomes:

• Estimated annual savings per nursing home resident: €686 (14% reduction)
• Estimated cost savings per patient episode: €2,530 (37% reduction)
• Total estimated annual cost savings: €934,908
• Costs calculated using actual unit costs (EMS, ED, inpatient, Mobile Hospital) and are visually summarised in Figure 1 on page 4

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