Healthcare resource use in patients of the Australian Transition Care Program
Tracy A. Comans A B E , Nancye M. Peel C , Ian D. Cameron D , Leonard Gray C and Paul A. Scuffham A BA Centre for Applied Health Economics, School of Medicine, Griffith University, University Drive, Meadowbrook, Qld 4105, Australia. Email: p.scuffham@griffith.edu.au
B Menzies Health Institute Queensland, Parklands Drive, Southport, Qld 4222, Australia.
C Centre for Research in Geriatric Medicine, The University of Queensland, Level 2, Building 33, Princess Alexandra Hospital, Ipswich Road, Woolloongabba, Qld 4102, Australia. Email: n.peel@uq.edu.au; len.gray@uq.edu.au
D John Walsh Centre for Rehabilitation Research, Sydney Medical School Northern, University of Sydney, Kolling Institute, Royal North Shore Hospital, Reserve Road, St Leonards, NSW 2065, Australia. Email: ian.cameron@sydney.edu.au
E Corresponding author. Email: t.comans@griffith.edu.au
Australian Health Review 39(4) 411-416 https://doi.org/10.1071/AH14054
Submitted: 13 March 2014 Accepted: 27 January 2015 Published: 30 March 2015
Abstract
Objective The aim of the present study was to describe, from the perspective of the healthcare funder, the cost components of the Australian Transition Care Program (TCP) and the healthcare resource use and costs for a group of transition care clients over a 6-month period following admission to the program.
Methods A prospective cohort observational study of 351 consenting patients entering community-based transition care at six sites in two states in Australia from November 2009 to September 2010 was performed. Patients were followed up 6 months after admission to the TCP to ascertain current living status and hospital re-admissions over the follow-up period. Cost data were collected by transition care teams and from administrative data (hospital and Medicare records).
Results The TCP provides a range of services with most costs attributed to provision of personal care support, case management, physiotherapy and occupational therapy. Most healthcare costs up to 6 months after transition care admission were incurred from the hospital admission leading to transition care and from re-admissions. Orthopaedic conditions incurred the highest costs, with many of these for elective procedures and others resulting from falls. Hospital re-admission rates in the present study were 10% lower than in a previous evaluation of the TCP. Over 6 months, approximately 40% of patients in the study were re-admitted to hospital at an average cost of A$7038.
Conclusions Although the cost of the TCP is relatively high, it may have some impact on reducing hospital re-admissions and preventing or delaying residential care admissions.
What is known about the topic? A majority of healthcare costs occur in older age.
What does this paper add? Hospital costs, both initial and re-admissions, are the major contributor to healthcare costs in transition care recipients. Orthopaedic conditions are the most expensive to treat and neurological conditions are the most variable.
What are the implications for practitioners? Reducing the length of hospitalisation and reducing re-admissions for older frail people is a key economic concern for health services. Services such as the TCP aim to do both; however, the evidence that this is effective is limited. Streamlining referrals to transition care to enable earlier access and involving the transition care provider in re-admission decisions may help reduce healthcare costs in future.
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