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 postrecruitment.
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.
Conclusion: A model of care that facilitates
access to community health services and provides
coordination between existing services
reduces hospital demand.
Integrated care facilitation for older patients with complex health care needs reduces hospital demand