Connecting Hospital and Community Care: The Acceptability of a Regional Data Linkage Scheme

Article excerpt

Abstract

Lack of information on an individual's premorbid needs and services in place can impede the transition from community to acute care. We report on a trial of an electronic data linking system between Flinders Medical Centre and Metropolitan Domiciliary Care. A sample of 82 medical, nursing and allied-health staff across the organisations completed questionnaires concerning their level of satisfaction with the trialled system. Results supported the effectiveness of an electronic data linking system across the hospitalcommunity interface. This system was effective in reducing labour costs, increasing organisational communication and devising appropriate discharge plans. Community staff indicated they were better informed about their client's medical and disability status and were able to play an active role in their client's treatment. This study provides more support to the implementation of a patient electronic data linking system focussed on older patients, with wider benefits including the reduction of unnecessarily long admission times and decreased demand on hospital beds.

Aust Health Rev 2005: 29(1): 12-16

INTERNATIONALLY THERE HAS BEEN a movement from institutionalised or hospital care for older people towards less expensive community-based care.1 As services are redirected away from the acute sector, a need has developed within the health system to integrate aged care sectors.2 This is complex, but essential to improving health outcomes for older people, and is a focus of health system reform. In Australia, Phases 3 and 4 of the National Demonstration Hospitals Program (NDHP) supported projects that enhanced integration between hospitals and the community sector,3 and we describe one project which used information technologies (IT) to promote integration of aged care services.

The electronic linking of patient health information between the hospital and community sectors to facilitate information sharing was identified as a key initiative in an NDHP4 project conducted in Adelaide, South Australia. The aim of this study was to pilot the effectiveness of electronic data linking tools to assist in the transfer of information between an acute care hospital and the main regional provider of home-based care.

Methods

Flinders Medical Centre (FMC) and Metropolitan Domiciliary Care Southern Region (MDCS) took part in this study. FMC is a 450-bed public university teaching hospital and houses the busiest emergency department (ED) in Adelaide. MDCS is a major provider of aged care community services offering support to the aged living at home. About 80% of admissions of older people at FMC are via the ED, of which 40%, or 8 to 10 admissions per day, are MDCS clients.

Before this study, an MDCS senior liaison nurse located at FMC provided clinicians at both sites with information about MDCS clients and assisted with discharge service planning. Identifying which patients were MDCS clients was performed manually with all patients admitted checked against a hard copy of the MDCS database (up to 4000 records). A fax was then sent to MDCS alerting the case manager of that patient's admission to FMC.

There were many shortcomings to this system. The MDCS listing was only updated monthly, missing newly referred clients. There was no coverage for the liaison nurse when that person was on leave. FMC staff also had no way of verifying whether a patient was a client of MDCS after hours or on weekends. Checking the status of community services during office hours often involved a lengthy phone call to MDCS and was dependent on the availability of a key worker to provide information over the phone. MDCS staff complained they were often not informed of discharge plans and that discharge summaries were rarely sent to them.

The data linking system between FMC and MDCS, known as 'Integration', developed in this study was piloted over 6 months in 2002-2003. The system involved three key components (see Box 1). …