Cost analysis of an integrated aged care program for residential aged care facilities
Rod Ling A B M , Andrew Searles A B , Jacqueline Hewitt C , Robyn Considine B D , Catherine Turner E , Susan Thomas F , Kelly Thomas G , Keith Drinkwater H , Isabel Higgins I , Karen Best J , Jane Conway K and Carolyn Hullick LA Hunter Medical Research Institute, Lot 1, Kookaburra Circuit, New Lambton Heights, NSW 2305, Australia. Email: andrew.searles@hmri.org.au
B University of Newcastle, School of Medicine and Public Health, University Drive, Callaghan, NSW 2308, Australia.
C Hunter New England Local Health District, Patient Flow Unit, Rankin Park Campus, Lookout Road, New Lambton Heights, NSW 2305, Australia. Email: jacqueline.hewitt@hnehealth.nsw.gov.au
D Consan Consulting, PO Box 560, The Junction, NSW 2291, Australia. Email: robyn.considine@newcastle.edu.au
E Hunter New England Central Coast Primary Health Network, 159 The Entrance Road, Erina, NSW 2250, Australia. Email: cturner@hneccphn.com.au
F Hunter New England Population Health, Locked Bag 10, Wallsend, NSW 2287, Australia. Email: susan.thomas3@hnehealth.nsw.gov.au
G Suncorp, GPO Box 1464, Sydney, NSW 2000. Email: kelly_0407@outlook.com
H Hunter Primary Care, 123 King Street, Newcastle, NSW 2300, Australia. Email: kdrinkwater@hunterprimarycare.com.au
I University of Newcastle, Older Person School of Nursing and Midwifery, University Drive, Callaghan,NSW 2308, Australia. Email: isabel.higgins@newcastle.edu.au
J Anglican Care Hunter and Central Coast Residential Care Services, 87 Toronto Road, Booragul, NSW 2284, Australia. Email: karenbest@anglicancare.com.au
K School of Rural Medicine, University of New England, Armidale, NSW 2351, Australia. Email: jconway4@une.edu.au
L Hunter New England Local Health District, Emergency Medicine and Clinical Governance, Lookout Road, New Lambton Heights, NSW 2305, Australia. Email: carolyn.hullick@hnehealth.nsw.gov.au
M Corresponding author. Email: rod.ling@hmri.org.au
Australian Health Review 43(3) 261-267 https://doi.org/10.1071/AH16297
Submitted: 22 December 2016 Accepted: 1 December 2017 Published: 1 February 2018
Journal Compilation © AHHA 2019 Open Access CC BY-NC-ND
Abstract
Objective To compare annual costs of an intervention for acutely unwell older residents in residential age care facilities (RACFs) with usual care. The intervention, the Aged Care Emergency (ACE) program, includes telephone clinical support aimed to reduce avoidable emergency department (ED) presentations by RACF residents.
Methods This costing of the ACE intervention examines the perspective of service providers: RACFs, Hunter Medicare Local, the Ambulance Service of New South Wales, and EDs in the Hunter New England Local Health District. ACE was implemented in 69 RACFs in the Hunter region of NSW, Australia. Analysis used 14 weeks of ACE and ED service data (June–September 2014). The main outcome measure was the net cost and saving from ACE compared with usual care. It is based on the opportunity cost of implementing ACE and the opportunity savings of ED presentations avoided.
Results Our analysis estimated that 981 avoided ED presentations could be attributed to ACE annually. Compared with usual care, ACE saved an estimated A$921 214.
Conclusions The ACE service supported a reduction in avoidable ED presentations and ambulance transfers among RACF residents. It generated a cost saving to health service providers, allowing reallocation of healthcare resources.
What is known about the topic? Residents from RACFs are at risk of further deterioration when admitted to hospital, with high rates of delirium, falls, and medication errors. For this cohort, some conditions can be managed in the RACF without hospital transfer. By addressing avoidable presentations to EDs there is an opportunity to improve ED efficiency as well as providing care that is consistent with the resident’s goals of care. RACFs generate some avoidable ED presentations for residents who may be more appropriately treated in situ.
What does this paper add? Telephone triaging with nursing support and training is a means by which ED presentations from RACFs can be reduced. One of the consequences of this intervention is ‘cost avoided’, largely through savings on ambulance costs.
What are the implications for practitioners? Unnecessary transfer from RACFs to ED can be avoided through a multicomponent program that includes telephone support with cost-saving implications for EDs and ambulance services.
Additional keywords: economic evaluation, emergency department, telephone triage, patient transfer.
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