hospital avoidance and substitution health service plan · pdf filehospital avoidance and...
TRANSCRIPT
Hospital Avoidance
and Substitution Health Service Plan
Discussion Paper
Consultation – Phase 1
September/October 2014
Hospital Avoidance
Unplanned presentations, admissions or readmissions to acute care facilities
Lengths of stay
People with highest risk of unplanned hospital presentation, admission, re-admission
Hospital Substitution
Home
CommunityPrimary health
Acute level care provided in a non-hospital setting
Home
Nursing home
Other. e.g. Medihotel
Allied health and nursing led screening and assessment clinics
Primary care to reduce PPHs
ACRE project
Hospital in the Home
Medihotels
Remote health monitoring technologies
Disinvestment
The case for change…Future bed
demand is
projected to
increase at a
much faster rate
than supply
…..this is
unsustainable,
business as
usual is not an
option.
Metro South Health Plans and Strategies
Queensland Health Reform
National Health Reform
Potentially Preventable Hospitalisations (PPHs). Hospital
readmissions. GP-type ED presentations. ED re-presentations.
Elective pre-operative beddays. Under-utilised HITH.
Policy and Planning Context Trends and Innovations
Challenges
3
Metro South Health Plans and Strategies
Queensland Health Reform
National Health Reform
National Healthcare
Agreement
PPHs
GP presentations to EDs
Readmissions
My Aged Care
HACC
Commonwealth Home Support Programme
“Contestability”
Chronic Disease Strategy
Prevention
Early detection and treatment
Integration of care
Self managementThe Queensland
Plan
Balance between prevention and treatment
Decline in lifestyle diseases
Healthy activities and food choices
MSH Strategic Plan
hospital avoidance and substitution programs and services toreduce hospital admissions by:
• Research and develop a formal plan for hospital avoidance and substitution in MSH
• Appropriate healthcare in appropriate settings as close as possible to where people live
• Innovations that support alternatives to hospital
Blueprint for
better healthcare
Preventativehealthcare
Wait times
Earlier discharge
Better coordination with primary care
Develop health partnerships
Health priorities 2014-15
Balance the system
Preventative and primary health
Health literacy
Assessment and screeningprograms
Outpatient demand management
Technology to provide servicesmore effectively
Pre-hospital emergency care initiatives with QAS
Services in alternative settings (e.g. HITH)
Disinvestment from low or no value practices/treatments
Recent strategies
MetroSouthHealth@Home
Central Referral Hub
CARE-PACT
End of life care planning
Allied Health Conservative Management Pathways –musculoskeletal & women’s health
Policy and Planning Context
4
Trends and Innovations
Challenges
•30% increase in PPHs from 2011-12 to 2012-13•Top PPHs – diabetes, pyelonephritis, COPD, dehydration and gastroenteritis, cellulitis, congestive cardiac failure
•20% 28-day readmission rate for overnight acute admissions 2012/13•Top readmission DRGs – Chest pain, COAD, Other digestive system diagnoses, Abdominal pain, heart failure and shock
PPHs and readmissions
•GP-type presentations decreasing, but still 18.6% of all ED activity.•Top GP-type presentations – ankle sprain, URTI, lacerated finger, viral infection, dressing change
•16% 28-day re-presentation rate in 2012/13•Top re-presentation diagnoses – dressing change, scheduled ED follow up, cellulitis – lower limb
GP-type presentations and re-presentations to
EDs
•$407,000 in potential lost funding for elective long stay admissions with pre-operative beddays in 2013/14 – ICU, urological, orthopaedic, neurosurgical procedures
•0.7% of acute separations managed by HITH in 2013/14. Below DoH target of 1.5%. Increased ALOS for some service using HITH – review.
Healthcare purchasing initiatives
Allied health and nursing led screening and assessment clinics - E.g. Physiotherapist in orthopaedic outpatients site, Nurse led endoscopy assessment clinic (2014 – Qld Nurse Endoscopy Model of Care)
Primary care to reduce PPHs - Multidisciplinary teams. Education-based. Increasing access. Disease-based ED Observation (Assessment) Units. Telemedicine and remote medicine.
ACRE (Accelerated Chest Pain Risk Evaluation) project - Accelerated diagnostic pathway for possible cardiac chest pain. Expected to lead to NEAT improvements and possible reduction in hospital admissions and LOS for chest pain.
Hospital in the Home - Especially for Cellulitis, Venous thrombosis, Pulmonary embolus, respiratory infection/inflammation, COPD, knee replacement.
Medihotels – suited to the needs of self-caring consumers accessing acute hospital services.
Remote health monitoring technologies – particularly in chronic disease patients for monitoring conditions such as cardiac failure, diabetes and COPD. Benefits: significant reductions in hospitalisation and mortality rates, lower travel costs, fewer home/outpatient clinic visits, self management education for patient.
Disinvestment – active disinvestment from unnecessary, ineffective, inefficient or harmful interventions to release resources for more efficient health resource allocation. E.g. arthroscopic surgery for knee osteoarthritis, imaging in cases of lower back pain.
5
Questions
• What do you see as the key challenges that could be improved through new or improved/expanded hospital avoidance or hospital substitution strategies?
• Which hospital avoidance or substitution strategies do you see as a priority for implementation or improvement/expansion?
• What issues do you see with implementing these priority strategies?
(E.g. staff capacity and/or capability, impact on other services, infrastructure, technology).
6
Contact
Holly McMillan
Project Manager, Health Service Planning
Metro South Health
[email protected] 3156 4982