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Reduction ofReduction of HospitalizationHospitalization CostCostafter after ImplementationImplementation of of CVMOCVMOProgram Program In In Hong KongHong Kong West West
Cluster Cluster ––The First Year ResultThe First Year Result
HA Convention 2007
Hong Kong West Community Geriatric Assessment Team, Fung Yiu King Hospital
Community Nursing Department, Queen Mary Hospital
• In HKWC, the Phase III CGAS/CVMO Collaboration Scheme has been started since May 2005
AIMs of the CVMO program
• To reduce A&E attendance and unplanned hospital admission POAHs (private old age homes)
• To provide quality medical care and enhance infection control in POAHs
• Cost reduction?
Members
• Geriatricians of HKWC• Community Visiting Medical Officer
(CVMO)• Community Geriatric Assessment
Team (CGAT) of FYK Hospital• Community Nurses (CN) of HKWC
• 8 POAHs with total capacity of 1,087 in HKWC were recruited in the project
• A full time CVMO with CGAT experience is responsible to conduct regular doctor’s clinic in POAHs 2 to 3 times per week
Targeted Patients
• High risk elderly whom recently attended A&E department or recently discharged from hospital
• Elderly with unstable medical condition
• Elderly with ad hoc medical problems
Role of the CVMO in POAHs
• Clinical assessment of patient’s condition after discharged from hospital or A&E
• Readjust and fine-tuning of treatment and medications
• Timely intervention of ad hoc medical problems
• Patient and staff education • Infection control
CVMO program reported in HA Convention 2006
• Preliminary six-month results (May to October 2005 compared with the same period 2004)
• There was:•11.6% reduction in A&E
attendance •18.3% reduction in
unplanned admission
Objectives of the present study
• To further examine the effect of one-year CVMO program on POAHsresidents in terms of– A&E attendance– Unplanned hospital admission– Length of hospital stay (LOS)– Cost of hospitalization
Study Period
• Retrospective approach• Study period: May 2005 to April
2006• Control period: May 2004 to April
2005
Control
5/04 5/05 4/06
CVMO started
Data Collection• Data collection:
– number of A&E attendance– number of hospital admissions (acute and
convalescence)– length of hospital stay
• Clinical admissions to medical subspecialitywards (e.g. renal ward for dialysis) or non-medical wards were excluded
• The difference in cost of hospital stay was calculated
Results• Total number of residents at the
beginning of the study: 615– 87 died– 19 moved out
• 509 residents included• Mean age: 82.4 (52 to 101)
– Male: 171 (33.6%)– Female: 338 (66.4%)
Sample CharacteristicsMobility % (N)
Ambulatory 49.3 (251)
Chairbound 44 (224)
Bedbound 6.8 (34)
BADL FunctionIndependent 38.7 (197)
Assisted 30.4 (155)
Dependent 30.8 (157)
FeedingOral 88.8 (452)
Ryles Tube 10.8 (55)
PEG 0.4 (2)
ContinenceContinent 44.4 (226)
Incontinent 55.6 (283)
CVS % (N) Gastrointestinal & Hepatobiliary % (N)
Heart Disease 27.7 (141) Liver Cirrhosis 1 (5)HT 60.5 (308) GIB 10.4 (53)Respiratory Endocrine
Asthma / COAD 6.9 (35) Diabetes Mellitus 25 (126)
7.8 (40)
Tuberculosis 6.7 (34) Thyroid Disorder 2.3 (12)Neurological and Psychiatric MiscellaneousCVA 38.9 (198) MalignancyDementia 27.7 (141) Anaemia 7.7 (39)Depression 5.5 (28) Cataract 14.5 (74)Epilepsy 3.5 (18) Fracture 19.6 (100)Parkinsonism 7.3 (37) Gout 10 (51)Psychosis 2.4 (12) LBP 6.6 (34)Renal Osteoarthritis 7.5 (38)Chronic Renal Failure 3.7 (19) Rheumatoid Arthritis 0.6 (3)
Chronic Disease Profile
A&E Attendance And Hospital Admissions
21
169
19
336
142
422
0
50
100
150
200
250
300
350
400
450
Clinical Hospital Admission Unplanned HospitalAdmission
A&E Attendance WithoutAdmission
Before After
One year after CVMO program
• A reduction of 27 (169 to 142) A&E attendance – =reduction from 0.33 to 0.28
attendance/person/year– =15.2% reduction
• A reduction of 86 (422 to 336) unplanned hospital admission– = reduction from 0.83 to 0.66
admission/person/year – =20.5% reduction
Case scenario 1• Ms Leung, age:86• DM, HT, history of AMI in 2003 &
2004
Admission Records
Date DiagnosisRH
RH
RH
QMH
RH
RH
RH
22/2/05 – 26/2/05 CHF
17/7/05 – 22/7/05 poor DM control
28/7/05 – 9/8/05 CHF
29/8/05 – 31/8/05 poor DM control
2/9/05 – 10/9/05 UTI, poor DM control
16/9/05 – 27/9/05 CHF
29/9/05 – 6/10/05 CHF
What we did…
• a case conference was conducted including geriatrician, CVMO, CGAT Geriatric nurses, Community nurses and OAH staff about patient’s condition and formulation of management plan
• patient was follow up weekly by CVMO to review DM control and hydration status, and drug titration if necessary
Outcome is…
• DM control greatly improved and patient did not have heart failure symptoms after treatment
• no further A&E attendance or hospitalization
Case Scenario 2• M/63• PH: cervical myelopathy on long term urinary
catheter• Repeated A&E attendance and hospitalization
because of urinary tract infection and foleyblockage
• Collaborate with Community nurses and POAH staff for close monitoring:– urinary symptoms– urine flow from catheter– adjust the schedule of change foley catheter– antibiotics treatment in POAH
• The A&E attendance and hospitalization reduced afterwards
Hospital Bed Days
2278
2571
1938
2822
0
500
1000
1500
2000
2500
3000
Convalescence Hosp. Acute Hosp.
Before After
•Reduction of hospital bed days in:
– Acute hospital: 340 days– Convalescence hospital: 251 days
Cost Reduction
• In HKWC, the cost of acute medical bed day is HK$ 2810
• In HKWC, the cost of convalescence hospital bed day is HK$1,400
• **HAHO Finance Department: Financial Reports and Information : 2005/06 costing information package
Total cost saved
• The cost saved after CVMO program is – $ 340 x 2810 = 955,400 in acute hospital – $ 251 x 1400 = 351,400 in convalescence
hospital
• Total cost saved: 955,400 + 351,400 = $1,306,800
Conclusion• The CVMO program is effective in
reducing:– A&E attendance– Unplanned hospital admission– Hospital bed days and cost of
hospitalization in acute and convalescence hospitals
THANK YOU
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