title: Reducing emergency department presentations among chronically ill patients in Western Sydney: a key role for coordinated primary care.
abstract: Coordination of health services is thought to improve health outcomes for patients with chronic and complex illness; however, there is limited quantitative evidence for the effectiveness of coordinated care programs. HealthOne Mount Druitt (HOMD) is a coordinated care program operating in a disadvantaged area of Western Sydney, Australia. It operates as a combination 'virtual' and 'hub and spoke' model, with care coordination provided by liaison nurses. We aimed to determine whether there were changes in the number of emergency department (ED) presentations, length of stay, and community health referrals in the 12 months following enrolment in HOMD, compared to the 12 months prior. A quantitative survey was also conducted to determine the perspectives of service providers on key aspects of HOMD. Enrolment in HOMD was followed by reductions in both the number of ED presentations and the amount of time spent by patients in the ED. Community health referrals were increased, and the pattern of referral to different types of community health services was altered. This study provides quantitative evidence that a coordinated care intervention improves patient health outcomes.
authors.affiliation: Menzies Centre for Health Policy, University of Sydney, NSW, Level 6, Charles Perkins Centre, University of Sydney, NSW 2006, Australia.
authors.forename: Kylie-Ann
authors.initials: KA
authors.lastname: Mallitt
authors.affiliation: Menzies Centre for Health Policy, University of Sydney, NSW, Level 6, Charles Perkins Centre, University of Sydney, NSW 2006, Australia.
authors.forename: Justin
authors.initials: J
authors.lastname: McNab
authors.affiliation: Primary Care and Community Health Services, Nepean Blue Mountains Local Health District, 288-292 Macquarie Road, Springwood, NSW 2777, Australia.
authors.forename: Rod
authors.initials: R
authors.lastname: Hughes
authors.affiliation: Western Sydney Medicare Local, WentWest Limited, Level 1, 85 Flushcombe Road, Blacktown, NSW 2148, Australia.
authors.forename: Joanne
authors.initials: J
authors.lastname: Fernyhough
authors.affiliation: HealthOne, Mount Druitt Community Health Centre, Buran Close, Mount Druitt, NSW 2770, Australia.
authors.forename: Janis
authors.initials: J
authors.lastname: Paterson
authors.affiliation: Department of General Practice, School of Medicine, Western Sydney University, Locked Bag 1797 Penrith, NSW 2751, Australia.
authors.forename: Di
authors.initials: D
authors.lastname: O'Halloran
mesh_terms: D001315:Australia; D002908:Chronic Disease / Q000628:therapy*; D003153:Community Health Services; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data*; D006801:Humans; D011320:Primary Health Care / Q000458:organization & administration*; D012017:Referral and Consultation