Academic journal article Australian Health Review

Healthcare Resource Use in Patients of the Australian Transition Care Program

Academic journal article Australian Health Review

Healthcare Resource Use in Patients of the Australian Transition Care Program

Article excerpt

Introduction

Governments are facing increasing pressures on health budgets, with the proportion of gross domestic product (GDP) allocated to health continuing to rise in Australia.1 The aging population is expected to be a key contributor to future increases in demand for health services, with estimates that healthcare spending will need to increase by 23% over the next two decades to meet the increased need for services for older Australians.2 Hospital spending is under particular scrutiny because these costs have risen at a far higher rate than any other sector of government spending.1 Australian research has shown that 12% of all admissions for general medical care are complicated by the inability to cope with activities of daily living,3 with most of these admissions likely to occur in older age groups. This has increased government interest in services that support older people to remain living in the community rather than being admitted to hospital or entering residential care prematurely. These support services have changed substantially over time with the development of the Home and Community Care Program, Community Aged Care Packages and Extended Aged Care in the Home by the Australian government. All contribute to the ability of older people to continue to manage at home.4 These services often require some time to implement and may not necessarily be suitable for the immediate post-hospital period when extra assistance is commonly needed.

In response to this, specific post-hospital services for older people in the form of the Transition Care Program (TCP) were implemented in Australia in 2005. The program targets older patients at the conclusion of a hospital episode who have been assessed as eligible for at least low-level residential aged care and who would benefit from support in a non-hospital environment to allow functional recovery.5 Clients usually receive the services in their own home; however, some older people enter a residential care TCP before transitioning to the community or entering permanent residential care. The program provides services such as: home help and personal care (up to daily); slow stream rehabilitation, including physiotherapy and occupational therapy (and sometimes other therapies and medical specialist services); nursing care; and case management.6 The guidelines for TCP provide funding for an expected length of stay (LOS) of 8 weeks with a maximum period of 12 weeks after discharge from hospital.5 The aims are to improve or actively maintain the person's capacity for independent living, so that inappropriate extended hospital LOS and premature admission to residential aged care are minimised. Patients are eligible to access the program from either public or private hospitals.

Previous research has demonstrated that both low- and highneeds recipients of TCP generally improve over the course of treatment and maintain that improvement for up to 6 months after discharge from hospital.7 Clinically meaningful improvements occurin bothfunctionalcapacity andqualityoflife,particularly in the domains of mobility, self-care and usual activities.7,8 Most recipients remain living in theirown home (>85%) after theend of the TCP episode.7

Despite growing concern in developed countries about aging populations and the feared future strain on healthcare budgets, little has been achieved in maintaining healthcare costs within the bounds of natural growth in age demographics and inflation. Evidence that the resources used, particularly on postacute health care for older people, represent value for money is lacking.9 Specific information about what the drivers of costs for healthcare are will enable better targeting of support programs like TCP to reduce the overall burden on the health system.

Objective

The aims of the present study were to describe, from the perspective of the health funder, the cost components of TCP and the healthcare resource use and costs for a group of TCP clients over a 6-month period following admission to the program. …

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