Cohort study of a specialist social worker intervention on hospital use for patients at risk of long stay

Osborne, Sonya and Harrison, Gai and O'Malia, Angela and Barnett, Adrian Gerard and Carter, Hannah E. and Graves, Nicholas (2018) Cohort study of a specialist social worker intervention on hospital use for patients at risk of long stay. BMJ Open, 8 (12 (e023127)). pp. 1-6.

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Abstract

Abstract
Background Long-stay patients in acute hospitals commonly present with complex psychosocial needs and use high levels of hospital resources.

Objective
To determine whether a specialist social worker-led model of care was associated with a reduction in length of stay for medically stable patients with complex psychosocial needs who were at risk of long stay, and to determine the economic value of this model relative to the decision makers’ willingness to pay for bed days released.

Design
A prospective, matched cohort study with historical controls.

Setting
A large, tertiary teaching and referral hospital in metropolitan Southeast Queensland, Australia.

Methods
Length of hospital stay for a cohort of patients seen under the specialist social worker-led model of care was compared with a matched control group of patients admitted to the hospital prior to the introduction of the new model of care using a multistate model with the social worker model of care as an intermediate event. Costs associated with the model of care were calculated and an estimate of the ‘cost per bed day’ was produced.

Results
The model of care reduced mean length of stay by 33 days. This translated to 9999 bed days released over 12 months. The cost to achieve this was estimated to be $A229 000 over 12 months. The cost per bed day released was $23, which is below estimates of hospital decision makers’ willingness to pay for a bed day to be released for an alternate use.

Conclusions
The specialist social worker-led model of care was associated with a reduced length of stay at a relatively low cost. This is likely to represent a cost effective use of hospital resources. The limitations of our historic control cohort selection mean that results should be interpreted with caution. Further research is needed to confirm these findings.


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Item Type: Article (Commonwealth Reporting Category C)
Refereed: Yes
Item Status: Live Archive
Additional Information: Published version made available under the Creative Commons Attribution 4.0 Unported (CC BY 4.0) license.
Faculty / Department / School: Current - Faculty of Health, Engineering and Sciences - School of Nursing and Midwifery
Date Deposited: 19 Feb 2019 06:25
Last Modified: 18 Mar 2019 04:16
Uncontrolled Keywords: hospital; social worker intervention; long stay patients; stranded patients economic evaluation cohort study
Fields of Research : 11 Medical and Health Sciences > 1199 Other Medical and Health Sciences > 119999 Medical and Health Sciences not elsewhere classified
Socio-Economic Objective: E Expanding Knowledge > 97 Expanding Knowledge > 970111 Expanding Knowledge in the Medical and Health Sciences
C Society > 92 Health > 9202 Health and Support Services > 920201 Allied Health Therapies (excl. Mental Health Services)
Identification Number or DOI: 10.1136/bmjopen-2018-023127
URI: http://eprints.usq.edu.au/id/eprint/35879

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