NSW Hospital in the HomeNSW Hospital in the Home Guideline

20th September 201320 September 2013

Annette MarleyPrincipal Project Officer

System Relationships BranchNSW Ministry of Healthy

OVERVIEWOVERVIEW

2010 HITH workshop findingsp g

CAPAC was not the right termg

Needed a clearer definition of HITH

Needed accurate consistent data and KPIs

Focus on more than the 8 avoidable DRGs

Wanted clear guidelines

St d di di & ti d Standardise recording & reporting and enable comparison between HITH services

A request for information sharing

Key drivers for changeKey drivers for change

In the current climate of state and national healthIn the current climate of state and national health reform, NSW is leveraging key strategies to drive change for HITH

Local Health District Service Agreement measures

NSW 2021 G l 11 K i l h lth d NSW 2021 Goal 11 – Keeping people healthy and out of hospital

National Emergency Access/Elective Surgery Targets (NEAT/NEST)

Activity Based Funding (ABF)

Hospital in the Home ProgramHospital in the Home Program

Objectives

NSW HITH services have consistent, measurable ,and clearly defined service delivery models

NSW Local Health Districts and Specialty HealthNSW Local Health Districts and Specialty Health Networks have a clearly defined strategy to increase their HITH capacity to meet the needs of specific target patient groups and their broader community

NSW Hospital in the HomeNSW Hospital in the Home 67 services delivering HITH g

care

Range of service delivery models

Achievements to date Increased service numbers

18,000 HITH admissions,

52,505 episodes in 2011/12 (33,902 in 07/08)

Reduced ALOS

NSW Hospital in the Home GuidelineObjectivesObjectives

To provide clear standardised Local development of To provide clear, standardised guidance regarding definitions, key elements and principles

Local development of service delivery models to meet local needs

Consistency of reporting, defined data measurable data-to enable coding counting &

Reduce variation, to achieve best practice across the stateto enable coding counting &

costing & enable ABF

Improved HITH service

the state

Incremental increase in % acute separations admitted toImproved HITH service

planning acute separations admitted to HITH

NSW Hospital in the Home DefinitionNSW Hospital in the Home Definition

Hospital in the Home (HITH) services provide acute and post-acute care to children and adults residing outside hospital, as a substitution or prevention of in-hospital p , p pcare. The place of residence may be permanent or temporary.

A person may receive their care at home (including Residential Aged Care Facilities), in a community setting at school or in the workplacesetting, at school or in the workplace.

HITH care is short-term and preferably interdisciplinaryp y

NSW Hospital in the Home DefinitionNSW Hospital in the Home DefinitionDaily HITH An individual requiring at least daily clinical care and

assessment of their treatment needs - clinically equivalent to an admitted patientan admitted patient

Daily HITH substitutes for inpatient care Meets the national definition

Intermittent HITH An individual with predominantly post-acute care needs who

requires less than daily clinical assessment of their treatment needs

Intermittent HITH is clinically equivalent to non-admitted careIntermittent HITH is clinically equivalent to non admitted care.

Consistency in Terminology Daily / Intermittent- Patient care need is the acuity

and intensity of care required by an individual

Coding of Daily HITH patients to bed type 25.

Coding of Intermittent HITH patients to service type g p yp225.

Clinical Management, Care setting and Patient careClinical Management, Care setting and Patient care need.

Consistency in ProcessesCli i l H d Clinical Handover

Referral Processes/Ease of Access

Data processes for capturing bed type 25 Daily HITH

Data processes must capture the transition of a patient’s care need pbetween Daily and Intermittent HITH

Quality measurementQ y

After hours Procedures

ACTIVITY BASED FUNDINGACTIVITY BASED FUNDING AND HITH

HITH Care

To hospital ward via ED To HITH via Hospital Ward /ED To hospital ward via ED

Direct to hospital ward

To HITH via Hospital Ward /ED

Direct to HITH

At resolution of acute care needs

Patient Admitted to HITH Care

Patient dischargedfrom HITH care

Inpatient ward Daily HITH Intermittent HITH

Admitted patient bed type Admitted bed type 25 Non-Admitted Service Type 225

Ward Transfer Separation

HITH Care under ABF

To hospital ward via ED To HITH via Hospital Ward / ED

Daily HITH - Patient Admitted to HITH Care

To hospital ward via ED

Direct to hospital ward

To HITH via Hospital Ward / ED

Direct to HITH

Inpatient ward Daily HITH

Admitted patient bed type Admitted bed type 25

Ward Transfer

DRG – F63BFunding – $4,077

HITH Care

To hospital ward via ED

Intermittent HITH

Direct to hospital ward

Patient Admitted to HITH Care Patient discharged from HITH care

Inpatient ward Intermittent HITH

Admitted patient bed type Non-Admitted Service Type 225

Separation

Episode paymentDRG – F63BFunding – $4,077

Daily paymentTier 2 – 40.58Funding - $236Funding $4,077 Funding $236

MEASURING SUCCESSMEASURING SUCCESS

Measurement and Evaluation

Consistency in Measurement Looking over the fence By clearly defining and classifying

Hospital in the Home patients, LHDs/SHNs will be able to benchmarkLHDs/SHNs will be able to benchmark their HITH services with similar services and understand their HITH activity in relation to national and state activity targets.

HITH EvidenceHITH Evidence• Patient outcomes

– Targeting Avoidable Admissions

– Reduction in length of stayReduction in length of stay

– Reduction in readmissions

Reduced incidence of falls and hospital acquired– Reduced incidence of falls and hospital acquired infection

• Hospital

– Increase in inpatient beds

– Funding neutral?

HITH Evidence

HITH DRG Overnight top 10 State vs Campbelltown Hospital

Overnight Seps ALOS Facility ALOS

5.2

7.1

5.06.2

4.6

9.8

7.2 7.3

10.6

3 16.0

8.0

10.0

12.0

400500600700800900

G ALO

S

in M

onth

3.1

0.0

2.0

4.0

0100200300400

DRG

Seps i

Hith SepsHITH Beddays

Hith ALOSHITH ALOS at facility

J64B Cellulitis W/O Catastrophic or Severe CC 831 4299 5.2 4.1F63B Venous Thrombosis W/O Catastrophic or Severe CC 143 1010 7.1L63B Kidney and Urinary Tract Infections W/O Catastrophic or Severe CC 122 612 5.0 4.1F76B Arrhythmia, Cardiac Arrest and Conduction Disorders W/O Cat or Sev CC 100 616 6.2

Descriptions of Top 10 DRGs throughout NSW with High Volume Separations for the period

E62C Respiratory Infections/Inflammations  W/O CC 91 419 4.6 3.3E65B Chronic Obstructive Airways Disease W/O Catastrophic CC 82 802 9.8Z64A Other Factors Influencing Health Status 81 584 7.2 4.1E61B Pulmonary Embolism W/O Catastrophic CC 75 547 7.3Z63B Other Surgical Follow Up and Medical Care W/O Catastrophic CC 73 776 10.6D63Z Otitis Media and URI 63 195 3.1 1.9

Mandatory Service MeasuresMandatory Service MeasuresService agreement indicator KPI Definition

Service Agreement IndicatorsCalculation

Local Monitoring MeasuresLocal Monitoring Measures

HITH ROADSHOWSHITH ROADSHOWS

HITH Roadshows

The aim of this Roadshow is to launch the NSW Hospital in the Home (HITH) Guideline which describes p ( )key elements & principles of service delivery models, data collection and reporting rules.

Why should you come? HITH id i l t b tt t b tt HITH provides equivalent or better care, at better

value It is an essential strategy to meet the National It is an essential strategy to meet the National

Emergency Access Target Establish a plan to build HITH capacity locally

Road show site Day & time Date

WS LHD Westmead Hospital Thursday AM 5/9/13

CC LHD Gosford Hospital Thursday PM 12/9/13

S LHD & St Vincents Network RPA Hospital Thursday PM 26/09/13

W LHD D bb H it l T d AM 1/10/13W LHD Dubbo Hospital Tuesday AM 1/10/13

SES LHD St George Hospital Tuesday AM 8/10/13

Southern NSW LHD Queanbeyan Hospital Thursday 11.00-15 00

10/10/1315.00

Illawarra Shoalhaven LHD Wollongong Hospital Thursday PM 17/10/13

Nepean & Blue Mountains LHD Nepean Hospital Tuesday AM-TBC 22/10/13

Thursday AMMNC LHD Port Macquarie Hospital

Thursday AM-time?

24/10/13

HNE LHD John Hunter Hospital Tuesday PM 12/11/13

NNSW LHD Lismore Hospital Friday 11-14.00 15/11/13p y

NSLHD RNS Hospital Friday AM 22/11/13

SCHN Randwick site Thursday 12.30-3.30 PM

28/11/13

SW Syd LHD Campbelltown Hospital Friday AM 29/11/13

Murrumbidgee LHD Wagga Wagga HospitalWednesday 1-4AM

4/12/13

Confirmed sites 17/9/13 updated

NSW HITH Contact detailsNSW HITH Contact details

Rachel NashRachel NashPrincipal Project OfficerSystem Relationships & Frameworks BranchSystem Relationships & Frameworks Branchhttp://www.health.nsw.gov.au/performance/pages/HITH.aspx

rnash@doh.health.nsw.gov.au

(02) 9391 9632 (02) 9391 9632

Annette Marley 0477 351 723amarl@doh.health.nsw.gov.au

QUESTIONS?QUESTIONS?