An outcomes evaluation of an Australian Hospital in the Nursing Home admission avoidance programme

Abstract

Aims and objectives. To undertake an outcomes evaluation of a Hospital in the Nursing Home (HINH) admission avoidance programme. Background. Admission avoidance type services such as Hospital in the Home have a place in improving service delivery for certain population groups. Research related to HINH has been limited, derived from various different health care systems internationally and results are varied. Design. A quasi-experimental study was conducted at one regional hospital. Routinely collected health information system data from two separate data sources were linked to undertake analysis. Methods. Those in the intervention group were matched to a comparison group of patients on the basis of three characteristics (age, gender and diagnostic category). Other factors that could affect a patient's hospital outcomes and length of stay (LOS) were statistically controlled for. Participants were aged care facility residents enrolled in a HINH programme (n = 62) and a matched group receiving usual in-hospital care (n = 115). Emergency department (ED) outcome measures included LOS and re-presentation. Hospital admission–related outcome measures included episode of care LOS, in-hospital LOS and hospital readmission. Results. A significant independent relationship between HINH programme enrolment and shorter in-hospital LOS was identified even after adjusting for other characteristics OR 0Æ16 (95% CI 0Æ28, 0Æ99 p < 0Æ001). Conclusion. The HINH model evaluated, with its focus on delivering acute care for aged care facility residents, can impact on health service delivery. Relevance to clinical practice. With a demonstrated reduction in in-hospital LOS, the available bed space created can be used for other patients perhaps waiting in the ED or waiting for surgery.