Reducing emergency department presentations among chronically ill patients in Western Sydney: a key role for coordinated primary care
Kylie-Ann Mallitt A E , Justin McNab A G , Rod Hughes B , Joanne Fernyhough C , Janis Paterson D and Di O’Halloran FA Menzies Centre for Health Policy, University of Sydney, NSW, Level 6, Charles Perkins Centre, University of Sydney, NSW 2006, Australia.
B Primary Care and Community Health Services, Nepean Blue Mountains Local Health District, 288–292 Macquarie Road, Springwood, NSW 2777, Australia.
C Western Sydney Medicare Local, WentWest Limited, Level 1, 85 Flushcombe Road, Blacktown, NSW 2148, Australia.
D HealthOne, Mount Druitt Community Health Centre, Buran Close, Mount Druitt, NSW 2770, Australia.
E Faculty of Medicine, University of New South Wales, Wallace Wurth Building, 18 High Street, Kensington, NSW 2052, Australia.
F Department of General Practice, School of Medicine, Western Sydney University, Locked Bag 1797 Penrith, NSW 2751, Australia.
G Corresponding author. Email: justin.mcnab@sydney.edu.au
Australian Journal of Primary Health 23(2) 140-146 https://doi.org/10.1071/PY16012
Submitted: 3 February 2016 Accepted: 12 July 2016 Published: 17 August 2016
Abstract
Coordination of health services is thought to improve health outcomes for patients with chronic and complex illness; however, there is limited quantitative evidence for the effectiveness of coordinated care programs. HealthOne Mount Druitt (HOMD) is a coordinated care program operating in a disadvantaged area of Western Sydney, Australia. It operates as a combination ‘virtual’ and ‘hub and spoke’ model, with care coordination provided by liaison nurses. We aimed to determine whether there were changes in the number of emergency department (ED) presentations, length of stay, and community health referrals in the 12 months following enrolment in HOMD, compared to the 12 months prior. A quantitative survey was also conducted to determine the perspectives of service providers on key aspects of HOMD. Enrolment in HOMD was followed by reductions in both the number of ED presentations and the amount of time spent by patients in the ED. Community health referrals were increased, and the pattern of referral to different types of community health services was altered. This study provides quantitative evidence that a coordinated care intervention improves patient health outcomes.
Additional keywords: chronic illness, comorbidity, hospital admission, community health, length of stay, coordinated care.
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