A multidisciplinary, community-based program to reduce unplanned hospital admissions

Journal article


Wan, Ching Shan, Mitchell, Jade and Maier, Andrea B.. (2021). A multidisciplinary, community-based program to reduce unplanned hospital admissions. Journal of the American Medical Directors Association (JAMDA). 22(6), pp. 1331.e1-1331.e9. https://doi.org/10.1016/j.jamda.2020.09.034
AuthorsWan, Ching Shan, Mitchell, Jade and Maier, Andrea B.
Abstract

Objectives
To evaluate the effect of Hospital Admission Risk Program (HARP) on unplanned hospitalization, bed days, and mortality of enrolled individuals and to evaluate the cost-effectiveness of HARP.

Design
A retrospective longitudinal analysis of hospital administrative data.

Intervention
Individuals at risk of hospitalization were provided with multidisciplinary, community-based care support managed by care coordinators including integrated care planning, education, monitoring, service linkages, and general practitioner liaison over 6-9 months.

Setting and Participants
Individuals who were enrolled into 1 of 8 HARP chronic disease management programs between July 1, 2017, and June 30, 2018, at the Royal Melbourne Hospital, Australia.

Methods
Hospital admissions between 18 months before and 18 months after HARP enrollment were analyzed. Total hospital costs were compared between 18 months before and 12 months after HARP enrollment.

Results
A total of 1553 individuals with a median age of 71 years (interquartile range 60-81), 63.4% males, were admitted to HARP. Both unplanned hospitalizations and bed days were reduced during the HARP intervention compared to within 3 months before enrollment in each of the HARP management programs. After the HARP intervention, cardiac coach, cardiac heart failure, chronic respiratory, diabetes comanagement, and medication management programs had higher hospitalizations and bed days than individuals’ baseline of at least 3 months before HARP enrollment. Individuals in cardiac heart failure and chronic respiratory management programs had a higher mortality rate than other HARP chronic disease management programs. Individuals in cardiac coach, diabetes comanagement, and medication management programs had lower hospital costs during the HARP intervention compared to within 3 months before HARP enrollment.

Conclusions and Implications
HARP reduced unplanned hospitalization and bed days but did not return individuals’ hospital use to baseline before the intervention. The variations in mortality between HARP chronic disease management programs implies that condition-specific goals between programs is preferable.

Keywordsoutcome and process assessment; health care; chronic disease; aged; patient readmission; mortality; hospital costs
Year2021
JournalJournal of the American Medical Directors Association (JAMDA)
Journal citation22 (6), pp. 1331.e1-1331.e9
PublisherElsevier Inc.
ISSN1525-8610
Digital Object Identifier (DOI)https://doi.org/10.1016/j.jamda.2020.09.034
Scopus EID2-s2.0-85096374328
Open accessPublished as ‘gold’ (paid) open access
Research or scholarlyResearch
Page range1-9
Publisher's version
License
File Access Level
Open
Output statusPublished
Publication dates
Online06 Nov 2020
Publication process dates
Deposited02 Aug 2021
Permalink -

https://acuresearchbank.acu.edu.au/item/8w71v/a-multidisciplinary-community-based-program-to-reduce-unplanned-hospital-admissions

Download files


Publisher's version
  • 64
    total views
  • 24
    total downloads
  • 2
    views this month
  • 0
    downloads this month
These values are for the period from 19th October 2020, when this repository was created.

Export as

Related outputs

The effects of lifestyle and behavioural interventions on cancer recurrence, overall survival and quality of life in breast cancer survivors : A systematic review and network meta-analysis
Yeganeh, Ladan, Willey, Suzanne, Wan, Ching Shan, Khomami, Mahnaz Bahri, Chehrazi, Mohammad, Cook, Olivia and Webber, Kate. (2024). The effects of lifestyle and behavioural interventions on cancer recurrence, overall survival and quality of life in breast cancer survivors : A systematic review and network meta-analysis. Maturitas. 185, pp. 1-21. https://doi.org/10.1016/j.maturitas.2024.107977
Barriers and facilitators to implementing pressure injury prevention and management guidelines in acute care : A mixed-methods systematic review
Wan, Ching Shan, Cheng, Heilok, Musgrave-Takeda, Mika, Liu, Mark, Tobiano, Georgia, McMahon, Jake and McInnes, Elizabeth Catherine. (2023). Barriers and facilitators to implementing pressure injury prevention and management guidelines in acute care : A mixed-methods systematic review. International Journal of Nursing Studies. 145, pp. 1-16. https://doi.org/10.1016/j.ijnurstu.2023.104557
Oedema as a predictor of the incidence of new pressure injuries in adults in any care setting : A systematic review and meta-analysis
Chaboyer, Wendy, Coyer, Fiona, Harbeck, Emma, Thalib, Lukman, Latimer, Sharon, Wan, Ching Shan, Tobiano, Georgia, Griffin, Bronwyn R., Campbell, Jill L., Walker, Rachel, Carlini, Joan J., Lockwood, Ishtar, Clark, Justin and Gillespie, Brigid M.. (2022). Oedema as a predictor of the incidence of new pressure injuries in adults in any care setting : A systematic review and meta-analysis. International Journal of Nursing Studies. 128, p. Article 104189. https://doi.org/10.1016/j.ijnurstu.2022.104189
Sarcopenia is associated with mortality in adults : A systematic review and meta-analysis
Xu, Jane, Wan, Ching S., Ktoris, Kiriakos, Reijnierse, Esmee M. and Maier, Andrea B.. (2022). Sarcopenia is associated with mortality in adults : A systematic review and meta-analysis. Gerontology. 68, pp. 361-376. https://doi.org/10.1159/000517099
Sarcopenia is associated with 3-month and 1-year mortality in geriatric rehabilitation inpatients : RESORT
Xu, Jane, Reijnierse, Esmee M., Pacifico, Jacob, Wan, Ching S. and Maier, Andrea B.. (2021). Sarcopenia is associated with 3-month and 1-year mortality in geriatric rehabilitation inpatients : RESORT. Age and Ageing. 50(6), pp. 2147-2156. https://doi.org/10.1093/ageing/afab134
Ethnic differences in barriers and enablers to physical activity among older adults
You, Emily, Lautenschlager, Nicola T., Wan, Ching Shan, Goh, Anita M. Y., Curran, Eleanor, Chong, Terence W. H., Anstey, Kaarin J., Hanna, Fahad and Ellis, Kathryn A.. (2021). Ethnic differences in barriers and enablers to physical activity among older adults. Frontiers in Public Health. 9, p. Article 691851. https://doi.org/10.3389/fpubh.2021.691851
Risk factors of readmissions in geriatric rehabilitation patients : RESORT
Wan, Ching S., Reijnierse, Esmee M. and Maier, Andrea B.. (2021). Risk factors of readmissions in geriatric rehabilitation patients : RESORT. Archives of Physical Medicine and Rehabilitation. 102(8), pp. 1524-1532. https://doi.org/10.1016/j.apmr.2021.01.082
Ethnic differences in dietary management of gestational diabetes mellitus : A mixed methods study comparing ethnic chinese immigrants and Australian women
Wan, Ching Shan, Teede, Helena, Nankervis, Alison and Aroni, Rosalie. (2020). Ethnic differences in dietary management of gestational diabetes mellitus : A mixed methods study comparing ethnic chinese immigrants and Australian women. Journal of the Academy of Nutrition and Dietetics. 120(1), pp. 86-102. https://doi.org/10.1016/j.jand.2019.08.019
Bioelectrical impedance analysis to estimate body composition, and change in adiposity, in overweight and obese adolescents : Comparison with dual-energy x-ray absorptiometry
Wan, Ching Shan, Ward, Leigh, Halim, Jocelyn, Gow, Megan L., Ho, Mandy, Briody, Julie, Leung, Kelvin, Cowell, Chris and Garnett, S. (2014). Bioelectrical impedance analysis to estimate body composition, and change in adiposity, in overweight and obese adolescents : Comparison with dual-energy x-ray absorptiometry. BMC Pediatrics. 14(1), pp. 1-10. https://doi.org/10.1186/1471-2431-14-249