Integrated care facilitation for older patients with complex health care needs reduces hospital demand.
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.


METHODS
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 timeframe.


CONCLUSIONS
A model of care that facilitates access to community health services and provides coordination between existing services reduces hospital demand.
School of Medical Sciences, RMIT University, PO Box 71, Bundoora, VIC 3083, and Centre for Population Health in the West, Sunshine Hospital, Melbourne, Australia. stephen.bird@rmit.edu.au
Stephen R
SR
Bird
William
W
Kurowski
Gillian K
GK
Dickman
Ian
I
Kronborg
D000368:Aged; D000369:Aged, 80 and over; D019090:Case Management; D019033:Delivery of Health Care, Integrated; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data*; D005260:Female; D016330:Frail Elderly; D006297:Health Services Accessibility; D006301:Health Services Needs and Demand; D006299:Health Services for the Aged / Q000458:organization & administration*; D006760:Hospitalization / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D008485:Medical Audit; D008875:Middle Aged; D017146:Models, Organizational; D014739:Victoria