Predictors of hospitalisations and emergency department presentations shortly after entering a residential aged care facility in Australia: a retrospective cohort study

ObjectivesTo: (1) examine the 90-day incidence of unplanned hospitalisation and emergency department (ED) presentations after residential aged care facility (RACF) entry, (2) examine individual-related, facility-related, medication-related, system-related and healthcare-related predictors of these outcomes and (3) create individual risk profiles.DesignRetrospective cohort study using the Registry of Senior Australians. Fine-Gray models estimated subdistribution HRs and 95% CIs. Harrell’s C-index assessed risk models’ predictive ability.Setting and participantsIndividuals aged ≥65 years old entering a RACF as permanent residents in three Australian states between 1 January 2013 and 31 December 2016 (N=116 192 individuals in 1967 RACFs).Predictors examinedIndividual-related, facility-related, medication-related, system and healthcare-related predictors ascertained at assessments or within 90 days, 6 months or 1 year prior to RACF entry.Outcome measures90-day unplanned hospitalisation and ED presentation post-RACF entry.ResultsThe cohort median age was 85 years old (IQR 80–89), 62% (N=71 861) were women, and 50.5% (N=58 714) had dementia. The 90-day incidence of unplanned hospitalisations was 18.0% (N=20 919) and 22.6% (N=26 242) had ED presentations. There were 34 predictors of unplanned hospitalisations and 34 predictors of ED presentations identified, 27 common to both outcomes and 7 were unique to each. The hospitalisation and ED presentation models out-of-sample Harrell’s C-index was 0.664 (95% CI 0.657 to 0.672) and 0.655 (95% CI 0.648 to 0.662), respectively. Some common predictors of high risk of unplanned hospitalisation and ED presentations included: being a man, age, delirium history, higher activity of daily living, behavioural and complex care needs, as well as history, number and recency of healthcare use (including hospital, general practitioners attendances), experience of a high sedative load and several medications.ConclusionsWithin 90 days of RACF entry, 18.0% of individuals had unplanned hospitalisations and 22.6% had ED presentations. Several predictors, including modifiable factors, were identified at the time of care entry. This is an actionable period for targeting individuals at risk of hospitalisations.

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Emergency Department access targets and the older patient: A retrospective cohort study of Emergency Department presentations by people living in Residential Aged Care Facilities

Australasian Emergency Nursing Journal ◽

10.1016/j.aenj.2012.10.002 ◽

2012 ◽

Vol 15 (4) ◽

pp. 211-218 ◽

Cited By ~ 8

Author(s):

Maryann Street ◽

Jonathan R. Marriott ◽

Patricia M. Livingston

Keyword(s):

Emergency Department ◽

Cohort Study ◽

Retrospective Cohort Study ◽

Retrospective Cohort ◽

Aged Care ◽

Residential Aged Care ◽

Older Patient ◽

Care Facilities ◽

Aged Care Facilities ◽

Residential Aged Care Facilities

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The effectiveness and cost effectiveness of a hospital avoidance program in a residential aged care facility: a prospective cohort study and modelled decision analysis

10.21203/rs.3.rs-18188/v4 ◽

2020 ◽

Author(s):

Hannah Carter ◽

Xing J. Lee ◽

Trudy Dwyer ◽

Barbara O’Neill ◽

Dee Jeffrey ◽

...

Keyword(s):

Cohort Study ◽

Cost Effectiveness ◽

Length Of Stay ◽

Hospital Admissions ◽

Care Facility ◽

Aged Care ◽

Residential Aged Care ◽

Aged Care Facility ◽

Residential Aged Care Facility ◽

The Cost

Abstract Background: Residential aged care facility residents experience high rates of hospital admissions which are stressful, costly and often preventable. The EDDIE program is a hospital avoidance initiative designed to enable nursing and care staff to detect, refer and quickly respond to early signals of a deteriorating resident. The program was implemented in a 96-bed residential aged care facility in regional Australia. Methods: A prospective pre-post cohort study design was used to collect data on costs of program delivery, hospital admission rates and length of stay for the 12 months prior to, and following, the intervention. A Markov decision model was developed to synthesize study data with published literature in order to estimate the cost-effectiveness of the program. Quality adjusted life years (QALYs) were adopted as the measure of effectiveness. Results: The EDDIE program was associated with a 19% reduction in annual hospital admissions and a 31% reduction in the average length of stay. The cost-effectiveness analysis found the program to be both more effective and less costly than usual care, with 0.06 QALYs gained and $249,000 health system costs saved in a modelled cohort of 96 residents. A probabilistic sensitivity analysis estimated that there was an 86% probability that the program was cost-effective after taking the uncertainty of the model inputs into account. Conclusions: This study provides promising evidence for the effectiveness and cost-effectiveness of a nurse led, early intervention program in preventing unnecessary hospital admissions within a residential aged care facility. Further research in multi-site randomised studies is needed to confirm the generalisability of these results.

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The effectiveness and cost effectiveness of a hospital avoidance program in a residential aged care facility: a prospective cohort study and modelled decision analysis

10.21203/rs.3.rs-18188/v3 ◽

2020 ◽

Author(s):

Hannah Carter ◽

Xing J. Lee ◽

Trudy Dwyer ◽

Barbara O’Neill ◽

Dee Jeffrey ◽

...

Keyword(s):

Cohort Study ◽

Cost Effectiveness ◽

Length Of Stay ◽

Hospital Admissions ◽

Care Facility ◽

Aged Care ◽

Residential Aged Care ◽

Aged Care Facility ◽

Residential Aged Care Facility ◽

The Cost

Abstract Background: Residential aged care facility residents experience high rates of hospital admissions which are stressful, costly and often preventable. The EDDIE program is a hospital avoidance initiative designed to enable nursing and care staff to detect, refer and quickly respond to early signals of a deteriorating resident. The program was implemented in a 96-bed residential aged care facility in regional Australia.Methods: A prospective pre-post cohort study design was used to collect data on costs of program delivery, hospital admission rates and length of stay for the 12 months prior to, and following, the intervention. A Markov decision model was developed to synthesize study data with published literature in order to estimate the cost-effectiveness of the program. Quality adjusted life years (QALYs) were adopted as the measure of effectiveness.Results: The EDDIE program was associated with a 19% reduction in annual hospital admissions and a 31% reduction in the average length of stay. The cost-effectiveness analysis found the program to be both more effective and less costly than usual care, with 0.06 QALYs gained and $249,000 health system costs saved in a modelled cohort of 96 residents. A probabilistic sensitivity analysis estimated that there was an 86% probability that the program was cost-effective after taking the uncertainty of the model inputs into account. Conclusions: This study provides promising evidence for the effectiveness and cost-effectiveness of a nurse led, early intervention program in preventing unnecessary hospital admissions within a residential aged care facility. Further research in multi-site randomised studies is needed to confirm the generalisability of these results.

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AgedCare+GP: description and evaluation of an in-house model of general practice in a residential aged-care facility

Australian Journal of Primary Health ◽

10.1071/py12151 ◽

2014 ◽

Vol 20 (3) ◽

pp. 224 ◽

Cited By ~ 6

Author(s):

Tilley Pain ◽

Lesley Stainkey ◽

Sue Chapman

Keyword(s):

Emergency Department ◽

General Practice ◽

Medical Model ◽

Care Facility ◽

Aged Care ◽

Residential Aged Care ◽

Service Model ◽

Aged Care Facility ◽

Residential Aged Care Facility ◽

Gp Services

This paper describes a medical model to provide in-house GP services to residents of aged-care facilities. Access to GP services for aged-care residents is decreasing, partially due to the changing demographic of the Australian GP workforce. The model we have developed is an in-house GP (AgedCare+GP) trialled in a publicly funded residential aged-care facility (RACF). The service model was based on the GP cooperative used in our after-hours general practice (AfterHours+GP). Briefly, the service model involves rostering a core group of GPs to provide weekly sessional clinics at the RACF. Financial contributions from appropriate Medicare Benefits Schedule (MBS) items for aged-care planning (including chronic conditions) provided adequate funds to operate the clinic for RACF residents. Evaluation of the service model used the number of resident transfers to the local emergency department as the primary outcome measure. There were 37 transfers of residents in the 3 months before the commencement of the AgedCare+GP and 11 transfers over a 3-month period at the end of the first year of operation; a reduction of almost 70%. This project demonstrates that AgedCare+GP is a successful model for GP service provision to RACF residents, and it also reduces the number of emergency department transfers.

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The effectiveness and cost effectiveness of a hospital avoidance program in a residential aged care facility: a prospective cohort study and modelled decision analysis

10.21203/rs.3.rs-18188/v2 ◽

2020 ◽

Author(s):

Hannah Carter ◽

Xing J. Lee ◽

Trudy Dwyer ◽

Barbara O’Neill ◽

Dee Jeffrey ◽

...

Keyword(s):

Cohort Study ◽

Cost Effectiveness ◽

Length Of Stay ◽

Hospital Admissions ◽

Care Facility ◽

Aged Care ◽

Residential Aged Care ◽

Aged Care Facility ◽

Residential Aged Care Facility ◽

The Cost

Abstract Background: Residential aged care facility residents experience high rates of hospital admissions which are stressful, costly and often preventable. The EDDIE program is a hospital avoidance initiative designed to enable nursing and care staff to detect, refer and quickly respond to early signals of a deteriorating resident. The program was implemented in a 96-bed residential aged care facility in regional Australia.Methods: A prospective pre-post cohort study design was used to collect data on costs of program delivery, hospital admission rates and length of stay for the 12 months prior to, and following, the intervention. A Markov decision model was developed to synthesize study data with published literature in order to estimate the cost-effectiveness of the program. Quality adjusted life years (QALYs) were adopted as the measure of effectiveness.Results: The EDDIE program was associated with a 19% reduction in annual hospital admissions and a 31% reduction in the average length of stay. The cost-effectiveness analysis found the program to be both more effective and less costly than usual care, with 0.06 QALYs gained and $249,000 health system costs saved in a modelled cohort of 96 residents. A probabilistic sensitivity analysis estimated that there was an 86% probability that the program was cost-effective after taking the uncertainty of the model inputs into account. Conclusions: This study provides promising evidence for the effectiveness and cost-effectiveness of a nurse led, early intervention program in preventing unnecessary hospital admissions within a residential aged care facility. Further research in multi-site randomised studies is needed to confirm the generalisability of these results.

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The effectiveness and cost effectiveness of a hospital avoidance program in a residential aged care facility: a prospective cohort study and modelled decision analysis

BMC Geriatrics ◽

10.1186/s12877-020-01904-1 ◽

2020 ◽

Vol 20 (1) ◽

Author(s):

Hannah E. Carter ◽

Xing J. Lee ◽

Trudy Dwyer ◽

Barbara O’Neill ◽

Dee Jeffrey ◽

...

Keyword(s):

Cohort Study ◽

Cost Effectiveness ◽

Length Of Stay ◽

Hospital Admissions ◽

Care Facility ◽

Aged Care ◽

Residential Aged Care ◽

Aged Care Facility ◽

Residential Aged Care Facility ◽

The Cost

Abstract Background Residential aged care facility residents experience high rates of hospital admissions which are stressful, costly and often preventable. The EDDIE program is a hospital avoidance initiative designed to enable nursing and care staff to detect, refer and quickly respond to early signals of a deteriorating resident. The program was implemented in a 96-bed residential aged care facility in regional Australia. Methods A prospective pre-post cohort study design was used to collect data on costs of program delivery, hospital admission rates and length of stay for the 12 months prior to, and following, the intervention. A Markov decision model was developed to synthesize study data with published literature in order to estimate the cost-effectiveness of the program. Quality adjusted life years (QALYs) were adopted as the measure of effectiveness. Results The EDDIE program was associated with a 19% reduction in annual hospital admissions and a 31% reduction in the average length of stay. The cost-effectiveness analysis found the program to be both more effective and less costly than usual care, with 0.06 QALYs gained and $249,000 health system costs saved in a modelled cohort of 96 residents. A probabilistic sensitivity analysis estimated that there was an 86% probability that the program was cost-effective after taking the uncertainty of the model inputs into account. Conclusions This study provides promising evidence for the effectiveness and cost-effectiveness of a nurse led, early intervention program in preventing unnecessary hospital admissions within a residential aged care facility. Further research in multi-site randomised studies is needed to confirm the generalisability of these results.

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The effectiveness and cost effectiveness of a hospital avoidance program in a residential aged care facility: a prospective cohort study and modelled decision analysis

10.21203/rs.3.rs-18188/v1 ◽

2020 ◽

Author(s):

Hannah Carter ◽

Xing J. Lee ◽

Trudy Dwyer ◽

Barbara O’Neill ◽

Dee Jeffrey ◽

...

Keyword(s):

Cohort Study ◽

Cost Effectiveness ◽

Length Of Stay ◽

Hospital Admissions ◽

Care Facility ◽

Aged Care ◽

Residential Aged Care ◽

Aged Care Facility ◽

Residential Aged Care Facility ◽

The Cost

Abstract Background: Residential aged care facility residents experience high rates of hospital admissions which are stressful, costly and often preventable. The EDDIE program is a hospital avoidance initiative designed to enable nursing and care staff to detect, refer and quickly respond to early signals of a deteriorating resident. The program was implemented in a 96-bed residential aged care facility in regional Australia.Methods: A prospective pre-post cohort study design was used to collect data on costs of program delivery, hospital admission rates and length of stay for the 12 months prior to, and following, the intervention. A Markov decision model was developed to synthesize study data with published literature in order to estimate the cost-effectiveness of the program. Quality adjusted life years (QALYs) were adopted as the measure of effectiveness.Results: The EDDIE program was associated with a 19% reduction in annual hospital admissions and a 31% reduction in the average length of stay. The cost-effectiveness analysis found the program to be both more effective and less costly than usual care, with 0.06 QALYs gained and $249,000 health system costs saved in a modelled cohort of 96 residents. A probabilistic sensitivity analysis estimated that there was an 86% probability that the program was cost-effective after taking the uncertainty of the model inputs into account. Conclusions: This study provides promising evidence for the effectiveness and cost-effectiveness of a nurse led, early intervention program in preventing unnecessary hospital admissions within a residential aged care facility. Further research in multi-site randomised studies is needed to confirm these results.

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Managing the wandering behaviour of people living in a residential aged care facility

JBI Library of Systematic Reviews ◽

10.11124/jbisrir-2007-232 ◽

2007 ◽

Vol 5 (8) ◽

pp. 454-496

Author(s):

Brent Hodgkinson ◽

Susan Koch ◽

Rhonda Nay ◽

Matthew Lewis

Keyword(s):

Care Facility ◽

Aged Care ◽

Residential Aged Care ◽

Aged Care Facility ◽

Residential Aged Care Facility

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Factors impacting hospital avoidance program utilisation in the care of acutely unwell residential aged care facility residents

BMC Health Services Research ◽

10.1186/s12913-021-06575-1 ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Luke Testa ◽

Tayhla Ryder ◽

Jeffrey Braithwaite ◽

Rebecca J. Mitchell

Keyword(s):

Care Facility ◽

Aged Care ◽

Residential Aged Care ◽

Nurse Specialist ◽

Structured Interviews ◽

Care Needs ◽

Aged Care Facility ◽

Enabling Factors ◽

Clinical Nurse ◽

Residential Aged Care Facility

Abstract Background An existing hospital avoidance program, the Aged Care Rapid Response Team (ARRT), rapidly delivers geriatric outreach services to acutely unwell or older people with declining health at risk of hospitalisation. The aim of the current study was to explore health professionals’ perspectives on the factors impacting ARRT utilisation in the care of acutely unwell residential aged care facility residents. Methods Semi-structured interviews were conducted with two Geriatricians, two ARRT Clinical Nurse Consultants, an ED-based Clinical Nurse Specialist, and an Extended Care Paramedic. Interview questions elicited views on key factors regarding care decisions and care transitions for acutely unwell residential aged care facility residents. Thematic analysis was undertaken to identify themes and sub-themes from interviews. Results Analysis of interviews identified five overarching themes affecting ARRT utilisation in the care of acutely unwell residents: (1) resident care needs; (2) family factors; (3) enabling factors; (4) barriers; and (5) adaptability and responsiveness to the COVID-19 pandemic. Conclusion Various factors impact on hospital avoidance program utilisation in the care of acutely unwell older aged care facility residents. This information provides additional context to existing quantitative evaluations of hospital avoidance programs, as well as informing the design of future hospital avoidance programs.

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