Program Evaluation of the Aged Care Early Intervention Management Strategy

Abstract

In 2001, there were an estimated 2.4 million Australians aged 65 and over, or 12.5% of the total population of 19.4 million. Over the next 50 years is it expected that one quarter of the total population will be aged 65 or over (Australian Institute of Health and Welfare [AIHW], 2002). In recent years, the priority attached to ageing issues has increased substantially in Australia and in most first world countries at both a national and international level. Concerns over the implications of population ageing have prompted responses to ensure the sustainability of economic, health and social support systems that are directly influenced by the changing age structure of the population. Older Australians are the largest consumers of health care. As a result of the general ageing process, older adults are at risk of developing iatrogenic complications associated with hospital admission. Services that have been implemented overseas and in Australia that aim to provide care for patients in their own environment include hospital in the home (HIH) and, more recently hospital in the nursing home (HINH). The ability to be able to deliver acute care within the Aged Care Facility (ACF) has not previously been evaluated extensively within Australia. Further, it is not known whether the HINH model utilised in a Queensland demonstration contained sufficient components to benefit patient care. Therefore, an evaluation of the structure, processes and outcomes of this model was conducted in order to inform all stakeholders involved and allow for further refinement. Thus, the aims of this research study were to: 1. Determine which factors predict poor outcomes for all older people who present to the ED and are admitted to hospital; 2. Determine whether HINH enrolment was a predictor for better outcomes for ACF residents; 3. Evaluate the structures involved in the HINH program; and 4. Evaluate the processes involved in the HINH program. In addressing these aims three phases of research were undertaken. The first was a precursor to the evaluation. It involved conducting a cohort study that described the clinical characteristics and outcomes of all acutely unwell older adults who presented to an Emergency Department (ED) in south-east Queensland. The second and third phases evaluated the HINH program that was implemented in order to improve the care pathway for ACF residents who presented to hospital. A structure, process and outcomes approach was used to do this. The second phase focussed on evaluating outcomes. A case control study was used to compare outcomes of ACF residents enrolled into the HINH program (cases) with ACF residents who were not enrolled into the program (controls). The third phase of this research evaluated the structures and processes of the HINH program using semi-structured interviews with doctors, nurses and HINH patients. This research has provided the first comprehensive evaluation of a HINH program within Australia utilising a structure, process and outcomes approach. Results from Phase 1 highlighted that negative outcomes occurred for ACF residents as well as the health care organisation when ACF residents presented to the ED and were admitted to hospital. Results from Phase 2 identified that enrolment into the HINH program had a significant positive impact on patient and health care organisation outcomes. Furthermore, by providing hospital care in the ACF, the HINH program, was a cheaper alternative to the standard in-hospital treatment, allowed for more in-hospital bed days to be available and reduced the risk of hospital related complications such as death for patients. Findings from Phase 3 showed that for this HINH program to operate, effective referral and communication strategies were integral. Given the current political climate that is concerned over the implications of population ageing, this evaluation is timely. The HINH program is one innovative model of health care delivery that benefits the economic, health and social support systems for ACF residents and the health care organisation.