The effectiveness and cost effectiveness of a hospital avoidance program in a residential aged care facility: a prospective cohort study and modelled decision analysis

Carter, Hannah E. and Lee, Xing J. and Dwyer, Trudy and O'Neill, Barbara and Jeffrey, Dee and Doran, Christopher M. and Parkinson, Lynne and Osborne, Sonya R. ORCID: https://orcid.org/0000-0002-2826-0627 and Reid-Searl, Kerry and Graves, Nicholas (2020) The effectiveness and cost effectiveness of a hospital avoidance program in a residential aged care facility: a prospective cohort study and modelled decision analysis. BMC Geriatrics, 20:527. pp. 1-9. ISSN 1471-2318

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Abstract

Background
Residential aged care facility residents experience high rates of hospital admissions which are stressful, costly and often preventable. The EDDIE program is a hospital avoidance initiative designed to enable nursing and care staff to detect, refer and quickly respond to early signals of a deteriorating resident. The program was implemented in a 96-bed residential aged care facility in regional Australia.

Methods
A prospective pre-post cohort study design was used to collect data on costs of program delivery, hospital admission rates and length of stay for the 12months prior to, and following, the intervention. A Markov decision model was developed to synthesize study data with published literature in order to estimate the costeffectiveness of the program. Quality adjusted life years (QALYs) were adopted as the measure of effectiveness.

Results
The EDDIE program was associated with a 19% reduction in annual hospital admissions and a 31% reduction in the average length of stay. The cost-effectiveness analysis found the program to be both more effective and less costly than usual care, with 0.06 QALYs gained and $249,000 health system costs saved in a modelled cohort of 96 residents. A probabilistic sensitivity analysis estimated that there was an 86% probability that the program was cost-effective after taking the uncertainty of the model inputs into account.

Conclusions
This study provides promising evidence for the effectiveness and cost-effectiveness of a nurse led, early intervention program in preventing unnecessary hospital admissions within a residential aged care facility. Further research in multi-site randomised studies is needed to confirm the generalisability of these results.


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Item Type: Article (Commonwealth Reporting Category C)
Refereed: Yes
Item Status: Live Archive
Faculty/School / Institute/Centre: Current - Faculty of Health, Engineering and Sciences - School of Nursing and Midwifery (1 Jan 2015 -)
Faculty/School / Institute/Centre: Current - Faculty of Health, Engineering and Sciences - School of Nursing and Midwifery (1 Jan 2015 -)
Date Deposited: 10 Dec 2020 02:00
Last Modified: 03 Jan 2021 23:43
Uncontrolled Keywords: hospital avoidance; residential aged care; regional Australia
Fields of Research (2008): 11 Medical and Health Sciences > 1110 Nursing > 111001 Aged Care Nursing
Fields of Research (2020): 42 HEALTH SCIENCES > 4205 Nursing > 420502 Aged care nursing
Socio-Economic Objectives (2008): E Expanding Knowledge > 97 Expanding Knowledge > 970111 Expanding Knowledge in the Medical and Health Sciences
E Expanding Knowledge > 97 Expanding Knowledge > 970114 Expanding Knowledge in Economics
Socio-Economic Objectives (2020): 20 HEALTH > 2003 Provision of health and support services > 200307 Nursing
Identification Number or DOI: https://doi.org/10.1186/s12877-020-01904-1
URI: http://eprints.usq.edu.au/id/eprint/40338

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