Hospital Avoidance

and Substitution Health Service Plan

Discussion Paper

Consultation – Phase 1

September/October 2014

Hospital Avoidance

Unplanned presentations, admissions or readmissions to acute care facilities

Lengths of stay

People with highest risk of unplanned hospital presentation, admission, re-admission

Hospital Substitution

Home

CommunityPrimary health

Acute level care provided in a non-hospital setting

Home

Nursing home

Other. e.g. Medihotel

Allied health and nursing led screening and assessment clinics

Primary care to reduce PPHs

ACRE project

Hospital in the Home

Medihotels

Remote health monitoring technologies

Disinvestment

The case for change…Future bed

demand is

projected to

increase at a

much faster rate

than supply

…..this is

unsustainable,

business as

usual is not an

option.

Metro South Health Plans and Strategies

Queensland Health Reform

National Health Reform

Potentially Preventable Hospitalisations (PPHs). Hospital

readmissions. GP-type ED presentations. ED re-presentations.

Elective pre-operative beddays. Under-utilised HITH.

Policy and Planning Context Trends and Innovations

Challenges

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Metro South Health Plans and Strategies

Queensland Health Reform

National Health Reform

National Healthcare

Agreement

PPHs

GP presentations to EDs

Readmissions

My Aged Care

HACC

Commonwealth Home Support Programme

“Contestability”

Chronic Disease Strategy

Prevention

Early detection and treatment

Integration of care

Self managementThe Queensland

Plan

Balance between prevention and treatment

Decline in lifestyle diseases

Healthy activities and food choices

MSH Strategic Plan

hospital avoidance and substitution programs and services toreduce hospital admissions by:

• Research and develop a formal plan for hospital avoidance and substitution in MSH

• Appropriate healthcare in appropriate settings as close as possible to where people live

• Innovations that support alternatives to hospital

Blueprint for

better healthcare

Preventativehealthcare

Wait times

Earlier discharge

Better coordination with primary care

Develop health partnerships

Health priorities 2014-15

Balance the system

Preventative and primary health

Health literacy

Assessment and screeningprograms

Outpatient demand management

Technology to provide servicesmore effectively

Pre-hospital emergency care initiatives with QAS

Services in alternative settings (e.g. HITH)

Disinvestment from low or no value practices/treatments

Recent strategies

MetroSouthHealth@Home

Central Referral Hub

CARE-PACT

End of life care planning

Allied Health Conservative Management Pathways –musculoskeletal & women’s health

Policy and Planning Context

4

Trends and Innovations

Challenges

•30% increase in PPHs from 2011-12 to 2012-13•Top PPHs – diabetes, pyelonephritis, COPD, dehydration and gastroenteritis, cellulitis, congestive cardiac failure

•20% 28-day readmission rate for overnight acute admissions 2012/13•Top readmission DRGs – Chest pain, COAD, Other digestive system diagnoses, Abdominal pain, heart failure and shock

PPHs and readmissions

•GP-type presentations decreasing, but still 18.6% of all ED activity.•Top GP-type presentations – ankle sprain, URTI, lacerated finger, viral infection, dressing change

•16% 28-day re-presentation rate in 2012/13•Top re-presentation diagnoses – dressing change, scheduled ED follow up, cellulitis – lower limb

GP-type presentations and re-presentations to

EDs

•$407,000 in potential lost funding for elective long stay admissions with pre-operative beddays in 2013/14 – ICU, urological, orthopaedic, neurosurgical procedures

•0.7% of acute separations managed by HITH in 2013/14. Below DoH target of 1.5%. Increased ALOS for some service using HITH – review.

Healthcare purchasing initiatives

Allied health and nursing led screening and assessment clinics - E.g. Physiotherapist in orthopaedic outpatients site, Nurse led endoscopy assessment clinic (2014 – Qld Nurse Endoscopy Model of Care)

Primary care to reduce PPHs - Multidisciplinary teams. Education-based. Increasing access. Disease-based ED Observation (Assessment) Units. Telemedicine and remote medicine.

ACRE (Accelerated Chest Pain Risk Evaluation) project - Accelerated diagnostic pathway for possible cardiac chest pain. Expected to lead to NEAT improvements and possible reduction in hospital admissions and LOS for chest pain.

Hospital in the Home - Especially for Cellulitis, Venous thrombosis, Pulmonary embolus, respiratory infection/inflammation, COPD, knee replacement.

Medihotels – suited to the needs of self-caring consumers accessing acute hospital services.

Remote health monitoring technologies – particularly in chronic disease patients for monitoring conditions such as cardiac failure, diabetes and COPD. Benefits: significant reductions in hospitalisation and mortality rates, lower travel costs, fewer home/outpatient clinic visits, self management education for patient.

Disinvestment – active disinvestment from unnecessary, ineffective, inefficient or harmful interventions to release resources for more efficient health resource allocation. E.g. arthroscopic surgery for knee osteoarthritis, imaging in cases of lower back pain.

5

Questions

• What do you see as the key challenges that could be improved through new or improved/expanded hospital avoidance or hospital substitution strategies?

• Which hospital avoidance or substitution strategies do you see as a priority for implementation or improvement/expansion?

• What issues do you see with implementing these priority strategies?

(E.g. staff capacity and/or capability, impact on other services, infrastructure, technology).

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Contact

Holly McMillan

Project Manager, Health Service Planning

Metro South Health

holly.mcmillan@health.qld.gov.au 3156 4982