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The effectiveness and cost effectiveness of a hospital avoidance program in a residential aged care facility

Hannah Carter, Xing Lee, Trudy Dwyer, Dee Jeffrey, Barbara O’Neill, Chris Doran, Lynne Parkinson, Sonya Osborne, Kerry Reid-Searl, Nicholas Graves
doi: https://doi.org/10.1101/523969
Hannah Carter
1Australian Centre for Health Services Innovation, Institute of Health and Biomedical Innovation, Queensland University of Technology
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Xing Lee
1Australian Centre for Health Services Innovation, Institute of Health and Biomedical Innovation, Queensland University of Technology
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Trudy Dwyer
2Central Queensland University
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Dee Jeffrey
3PresCare
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Barbara O’Neill
4Central Queensland University, University of Connecticut
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Chris Doran
1Australian Centre for Health Services Innovation, Institute of Health and Biomedical Innovation, Queensland University of Technology
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Lynne Parkinson
5Centre for Indigenous Health Equity Research, Central Queensland University
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Sonya Osborne
1Australian Centre for Health Services Innovation, Institute of Health and Biomedical Innovation, Queensland University of Technology
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Kerry Reid-Searl
2Central Queensland University
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Nicholas Graves
1Australian Centre for Health Services Innovation, Institute of Health and Biomedical Innovation, Queensland University of Technology
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Abstract

Background Residential aged care facility residents experience high rates of hospital admissions which are stressful, costly and often preventable.

Design Prospective pre-post cohort study and decision model analysis

Intervention A decision-support tool was implemented to enable nursing staff to detect, refer and quickly respond to early signals of a deteriorating resident. Advanced clinical skills training, new diagnostic equipment and guided support from clinical lead nurses and nurse practitioners was provided to support nursing staff in the delivery of appropriate sub-acute care.

Outcome measures Rate of hospital admissions; length of stay; incremental cost per QALY; net monetary benefit.

Results The hospital avoidance program was associated with a 19% reduction in annual hospital admissions and a 31% reduction in the average length of stay. When modelled in a cohort of 1,000 residents the program resulted in a total of 1,606 fewer hospital bed days per annum. This contributed to a total cost saving of $2.6 million and 0.62 incremental QALYs gained per 1,000 residents. The program had a positive net monetary benefit and was considered cost-effective, even when the willingness to pay for health care gains was set to zero. 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 compelling evidence for the effectiveness and cost-effectiveness of a RACF nurse led sub-acute care program in preventing unnecessary hospital admissions.

Acknowledgements

We thank the staff, residents and families at the Yaralla Aged Care Facility for their support in the implementation of the EDDIE intervention.

Footnotes

  • Declaration of Sources of Funding: This work was supported by an Australian Centre for Health Services Innovation Implementation Grant.

Copyright 
The copyright holder for this preprint is the author/funder, who has granted bioRxiv a license to display the preprint in perpetuity. It is made available under a CC-BY-NC-ND 4.0 International license.
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Posted January 18, 2019.
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The effectiveness and cost effectiveness of a hospital avoidance program in a residential aged care facility
Hannah Carter, Xing Lee, Trudy Dwyer, Dee Jeffrey, Barbara O’Neill, Chris Doran, Lynne Parkinson, Sonya Osborne, Kerry Reid-Searl, Nicholas Graves
bioRxiv 523969; doi: https://doi.org/10.1101/523969
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The effectiveness and cost effectiveness of a hospital avoidance program in a residential aged care facility
Hannah Carter, Xing Lee, Trudy Dwyer, Dee Jeffrey, Barbara O’Neill, Chris Doran, Lynne Parkinson, Sonya Osborne, Kerry Reid-Searl, Nicholas Graves
bioRxiv 523969; doi: https://doi.org/10.1101/523969

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