Academic journal article Australian Health Review

Integrated Care Facilitation for Older Patients with Complex Health Care Needs Reduces Hospital Demand

Academic journal article Australian Health Review

Integrated Care Facilitation for Older Patients with Complex Health Care Needs Reduces Hospital Demand

Article excerpt

Abstract

Objective: The evaluation of a new model of care for older people with complex health care needs that aimed to reduce their use of acute hospital services.

Method: Older people (over 55 years) with complex health care needs, who had made three or more presentations to a hospital emergency department (ED) in the previous 12 months, or who were identified by community health care agencies as being at risk of making frequent ED presentations, were recruited to the project. The participants were allocated a "care facilitator" who provided assistance in identifying and accessing required health care services, as well as education in aspects of self management. Data for the patients who had been participants on the project for a minimum of 90 days (n=231) were analysed for their use of acute hospital services (ED presentations, admissions and hospital bed-days) for the period 12-months pre-recruitment and post-recruitment. A similar analysis on the use of hospital services was conducted on the data of patients who were eligible and who had been offered participation, but who had declined (comparator group; n = 85).

Results: Post recruitment, the recruited patients displayed a 20.8% reduction in ED presentations, a 27.9% reduction in hospital admissions, and a 19.2% reduction in bed-days. By comparison, the patients who declined recruitment displayed a 5.2% increase in ED presentations, a 4.4 % reduction in hospital admissions, and a 15.3% increase in inpatient bed-days over a similar time- frame.

Conclusion: A model of care that facilitates access to community health services and provides coordination between existing services reduces hospital demand.

Aust Health Rev 2007: 31 (3): 451-461

IT IS WIDELY ACKNOWLEDGED that many countries face serious challenges in caring for a growing population of older people with multiple health problems. Part of this problem is that many health care systems have fragmented geriatric services, discontinuities within the system of geriatric care, system inefficiencies and a community/hospital split.1-5 In these systems, elderly patients may fail to receive all the services they require and, as a consequence, suffer detrimental impacts upon their health status and quality of life. Resulting from this are hospital presentations and a need for acute care, which could have been avoided. The aforementioned studies have therefore concluded that coordinated and integrated services are vital for effective care of the elderly, and in accordance with this, a number of initiatives have been implemented in attempts to provide a seamless system of geriatric health care. These include the US Programme of All-inclusive Care for Elderly People (PACE)6 and the Canadian system of integrated care for older persons (SIPA).7

In an attempt to provide more integrated service delivery and in recognition of the growing demand for hospital emergency services, the Department of Human Services Victoria initiated a statewide Hospital Admission Risk Program (HARP), which provided funding for projects aimed at reducing the demand on hospital services and improving patient health.8 In response to this HARP initiative, a group of acute and community-based health care providers, in the western suburbs of Melbourne, and representing all facets of health care, formed a consortium (Box 1) that successfully attained funding for several HARP projects. Each of these projects aimed to provide an integrated system of care, which, through the employment of care facilitators, ensured that patients were linked to all the existing acute and community services they required. They also facilitated the coordination between the services through ensuring effective communication and exchange of relevant information. This paper describes the format and outcomes of the project that was established for older people with complex care needs (Complex Needs Project [CNP]).

Project description

Target group identification

The consortium identified older people with multiple comorbidities and complex care needs as a group who frequently presented to hospital emergency departments (EDs), and whose use of hospital services could be reduced and general health improved via the implementation of a new model of care. …

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