Julia Crilly1, Wendy Chaboyer, Marianne Wallis, Lukman Thalib, Denise Polit. 1. Research Centre for Clinical and Community Practice Innovation, Southern District ED Clinical Network, C/o Emergency Department, Gold Coast Hospital, Southport, Australia. julia_crilly@health.qld.gov.au
Abstract
AIMS AND OBJECTIVES: To undertake an outcomes evaluation of a Hospital in the Nursing Home (HINH) admission avoidance programme. BACKGROUND: Admission avoidance type services such as Hospital in the Home have a place in improving service delivery for certain population groups. Research related to HINH has been limited, derived from various different health care systems internationally and results are varied. DESIGN: A quasi-experimental study was conducted at one regional hospital. Routinely collected health information system data from two separate data sources were linked to undertake analysis. METHODS: Those in the intervention group were matched to a comparison group of patients on the basis of three characteristics (age, gender and diagnostic category). Other factors that could affect a patient's hospital outcomes and length of stay (LOS) were statistically controlled for. Participants were aged care facility residents enrolled in a HINH programme (n = 62) and a matched group receiving usual in-hospital care (n = 115). Emergency department (ED) outcome measures included LOS and re-presentation. Hospital admission-related outcome measures included episode of care LOS, in-hospital LOS and hospital readmission. RESULTS: A significant independent relationship between HINH programme enrolment and shorter in-hospital LOS was identified even after adjusting for other characteristics OR 0·16 (95% CI 0·28, 0·99 p < 0·001). CONCLUSION: The HINH model evaluated, with its focus on delivering acute care for aged care facility residents, can impact on health service delivery. RELEVANCE TO CLINICAL PRACTICE: With a demonstrated reduction in in-hospital LOS, the available bed space created can be used for other patients perhaps waiting in the ED or waiting for surgery.
AIMS AND OBJECTIVES: To undertake an outcomes evaluation of a Hospital in the Nursing Home (HINH) admission avoidance programme. BACKGROUND: Admission avoidance type services such as Hospital in the Home have a place in improving service delivery for certain population groups. Research related to HINH has been limited, derived from various different health care systems internationally and results are varied. DESIGN: A quasi-experimental study was conducted at one regional hospital. Routinely collected health information system data from two separate data sources were linked to undertake analysis. METHODS: Those in the intervention group were matched to a comparison group of patients on the basis of three characteristics (age, gender and diagnostic category). Other factors that could affect a patient's hospital outcomes and length of stay (LOS) were statistically controlled for. Participants were aged care facility residents enrolled in a HINH programme (n = 62) and a matched group receiving usual in-hospital care (n = 115). Emergency department (ED) outcome measures included LOS and re-presentation. Hospital admission-related outcome measures included episode of care LOS, in-hospital LOS and hospital readmission. RESULTS: A significant independent relationship between HINH programme enrolment and shorter in-hospital LOS was identified even after adjusting for other characteristics OR 0·16 (95% CI 0·28, 0·99 p < 0·001). CONCLUSION: The HINH model evaluated, with its focus on delivering acute care for aged care facility residents, can impact on health service delivery. RELEVANCE TO CLINICAL PRACTICE: With a demonstrated reduction in in-hospital LOS, the available bed space created can be used for other patients perhaps waiting in the ED or waiting for surgery.
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