Effectiveness of a discharge planning and community support programme in preventing readmission of high-risk older patients

Abstract

Objective: To examine the effectiveness of Integrated Care and Discharge Support for elderly patients in reducing accident and emergency department attendance, acute hospital admissions, and hospital bed days after discharge. Factors that compromise its effectiveness were investigated and cost analysis was performed.Design: Cohort prospective study. Results: A total of 1090 older patients were studied. The Integrated Care and Discharge Support for elderly patients programme reduced accident and emergency department attendance by 40% (P<0.001), acute hospital admissions by 47% (P<0.001), and hospital bed days by 31% (P<0.001) at 6 months after implementation. Improvements in Barthel Index 20 (P<0.001) and Modified Functional Ambulation Category scale (P<0.001) were observed. Of the patients, 85 (7.8%) died within 6 months of initiation of the programme. Only 26 (2.4%) older patients required institutionalisation in residential care homes within 6 months after the programme. Increasing age (P=0.025) and high Charlson Comorbidity Index score (P=0.001) were positive predictors for accident and emergency department attendance. A high albumin level (P=0.001) and living alone (P=0.033) were negative predictors for Effectiveness of a discharge planning and community support programme in preventing readmission of high-risk older patients New knowledge added by this study • Integrated Care and Discharge Support for elderly patients (ICDS) reduced accident and emergency department (AED) attendances, acute hospital admissions, and hospital bed days. Setting• ICDS service was potentially cost-saving and might minimise institutionalisation.• Age, Charlson Comorbidity Index, albumin level, and living alone were associated with AED attendance.• Age, number of medications, and haemoglobin levels were associated with no reduction in bed days. Implications for clinical practice or policy • ICDS programme should be continued in Hong Kong to face the challenges of an increasing older population.• Further studies are suggested to examine whether AED attendance, acute hospital admissions, and hospital bed days among high-risk older patients can be further reduced by modifying some of the predictive factors identified in this study.• A more detailed auditing is warranted to show its value in reducing health care costs.

Collaborate across silos: Perceived barriers to integration of care for the elderly from the perspectives of service providers

“…To provide home care support, the cluster‐based Integrated Care and Discharge Support has been in operation since 2008; its purpose is to help achieve a gap‐free transition of care through collaborating with the NGOs, to formulate a better discharge care plan through assessment and care management, making referrals for rehabilitation services and community resources for patients and their families to the NGOs in the community. Evaluation of an Integrated Care Discharge programme shows that the Integrated Care Discharge model is effective in reducing accident and emergency department visits, acute hospital admissions, and hospital bed days to 6 months after implementation …”

Implementation of integrated geriatric care at a German hospital: a case study to understand when and why beneficial outcomes can be achieved

“…However, so far the evidence on the effectiveness of integrated care for people with geriatric conditions has been mixed. While some interventions were found to have contributed to a reduction in symptoms, emergency department visits, acute hospital admissions and hospital bed days [19, 20], other interventions showed no improvements in length of hospital stay, use of care, prevention of adverse outcomes, health status and costs [20–25]. In addition to this heterogeneity in outcomes, there was also a considerable variation in the interventions themselves, which ranged from telehealth education, discharge planning and community support, and multidisciplinary pathways to integration of acute, chronic and social care.…”

Impact of population ageing on growing demand for emergency transportation to emergency departments in Western Australia, 2005–2020

“…Many health institutions, including the WA Health Department, have taken steps to manage the increasing demand for ED services in older patients to reduce avoidable ED presentations and hospital admissions . Strategies include: patient education for improving self‐care and medication safety, enhanced primary care programmes that promote multidisciplinary care for chronic disease management, in acute settings, medication reconciliation, comprehensive discharge planning, including end of life planning, promoting appropriate care and improving transitional and continuity of care, the Four‐Hour Rule programme and the National Emergency Access Target (NEAT), clinical services redesign and central referral services to improve the process efficiency within hospitals and the system and reduce ambulance ramping.…”