title: Identifying patient-level health and social care costs for older adults discharged from acute medical units in England.
abstract: BACKGROUND
  acute medical units allow for those who need admission to be correctly identified, and for those who could be managed in ambulatory settings to be discharged. However, re-admission rates for older people following discharge from acute medical units are high and may be associated with substantial health and social care costs.
  
  
  OBJECTIVE
  identifying patient-level health and social care costs for older people discharged from acute medical units in England.
  
  
  METHODS
  a prospective cohort study of health and social care resource use.
  
  
  METHODS
  an acute medical unit in Nottingham, England.
  
  
  METHODS
  four hundred and fifty-six people aged over 70 who were discharged from an acute medical unit within 72 h of admission.
  
  
  METHODS
  hospitalisation and social care data were collected for 3 months post-recruitment. In Nottingham, further approvals were gained to obtain data from general practices, ambulance services, intermediate care and mental healthcare. Resource use was combined with national unit costs.
  
  
  RESULTS
  costs from all sectors were available for 250 participants. The mean (95% CI, median, range) total cost was £1926 (1579-2383, 659, 0-23,612). Contribution was: secondary care (76.1%), primary care (10.9%), ambulance service (0.7%), intermediate care (0.2%), mental healthcare (2.1%) and social care (10.0%). The costliest 10% of participants accounted for 50% of the cost.
  
  
  CONCLUSIONS
  this study highlights the costs accrued by older people discharged from acute medical units (AMUs): they are mainly (76%) in secondary care and half of all costs were incurred by a minority of participants (10%).
authors: Division for Social Research in Medicines and Health, School of Pharmacy, University of Nottingham, Nottingham, UK.
authors: Matthew
authors: M
authors: Franklin
authors: Division for Social Research in Medicines and Health, School of Pharmacy, University of Nottingham, Nottingham, UK.
authors: Vladislav
authors: V
authors: Berdunov
authors: Division of Rehabilitation and Ageing, School of Community Health Sciences, Medical School, Queens Medical Centre, University of Nottingham, Nottingham, UK.
authors: Judi
authors: J
authors: Edmans
authors: University of Leicester School of Medicine, Room 540, Clinical Sciences Building, Leicester Royal Infirmary, Leicester, UK.
authors: Simon
authors: S
authors: Conroy
authors: Division of Rehabilitation and Ageing, School of Community Health Sciences, Medical School, Queens Medical Centre, University of Nottingham, Nottingham, UK.
authors: John
authors: J
authors: Gladman
authors: Division for Social Research in Medicines and Health, School of Pharmacy, University of Nottingham, Nottingham, UK.
authors: Lukasz
authors: L
authors: Tanajewski
authors: Division for Social Research in Medicines and Health, School of Pharmacy, University of Nottingham, Nottingham, UK.
authors: Georgios
authors: G
authors: Gkountouras
authors: Division for Social Research in Medicines and Health, School of Pharmacy, University of Nottingham, Nottingham, UK.
authors: Rachel A
authors: RA
authors: Elliott
mesh_terms: D000367:Age Factors; D000368:Aged; D000552:Ambulances / Q000191:economics; D004739:England; D017048:Health Care Costs; D006302:Health Services Research; D006801:Humans; D007902:Length of Stay / Q000191:economics; D008605:Mental Health Services / Q000191:economics; D010351:Patient Discharge / Q000191:economics*; D011320:Primary Health Care / Q000191:economics; D011446:Prospective Studies; D063127:Secondary Health Care / Q000191:economics; D012947:Social Work / Q000191:economics*; D013222:State Medicine / Q000191:economics*; D013997:Time Factors
keywords: acute medical unit; costing methodology; economic evaluation; primary care; secondary care; social care