Alternatives to hospital care

Background

International and national evidence identify that some patients treated in their own home or in alternative settings to hospital achieve equivalent clinical outcomes with less expenditure and greater satisfaction.

There is an increasing body of evidence about the kind of patients most suited for home-based care; the pros and cons of hospital, home-based and mixed models; addressing caregiver needs; and cost benefits of different models of care.  

As demand for health care and the cost of delivering care increases, hospital substitution and avoidance models are a clinically effective and cost effective alternative to hospital care for some categories of patients. Hospital substitution provides hospital-level care in the patient’s home as an alternative to a traditional inpatient admission. For example, the Queensland Governments Blueprint for Better Healthcare in Queensland launched in 2013, commits to increased use of Hospital in the Home Services (HiTH) as a substitute model for traditional inpatient hospital care. Blue Care is one of two community based providers delivering HiTH in Queensland. 

Hospital avoidance models prevent an acute admission for patients who would otherwise be admitted to hospital. These include patients being managed under chronic disease management plans or post-acute care plans. 

Challenges and opportunities  

There are many opportunities in Queensland to develop and deliver a wider range of hospital substitution for clinically suitable patients. The sophistication and availability of telehealth and remote monitoring technologies also supports increased management of medical conditions at home. 
Opportunities for hospital substitution models include: peritoneal and haemo-dialysis, and education and monitoring for patients with chronic renal failure; the delivery of chemotherapy for patients with cancer; home based rehabilitation post orthopaedic surgery; enhanced palliative care and family support; earlier discharge for some patients, and pre-admission assessment. Currently HiTH services in Queensland are available to patients with a limited number of conditions (including cellulitis, pulmonary embolism, urinary tract Infection, and respiratory infection, and venous thrombosis). The application of telehealth and remote monitoring provides an opportunity to increase the scope and complexity of HITH services particularly to clients with chronic obstructive pulmonary disease and diabetes and those participating in cardiac rehabilitation. 

Similarly, the rapidly increasing availability and uptake of health technologies creates new opportunities to for people with chronic disease to avoid hospital care by managing and monitoring their condition at home. A range of elements need to be in place for this to happen: 
  • Home based monitoring, telehealth and other health information technologies; 
  • Appropriately trained staff to provide coordinated care through team-based models;
  • Payment models that compensate for care coordination and patient-centred care management that does involve not face to face assessment and care; and 
  • Flexible and integrated funding models that provide for a comprehensive range and mix of private and publicly delivered services.  

Hospital substitution and avoidance models can be developed and implemented through a range of approaches including partnerships and collaborative workforce models between local service providers and acute care services; pubic private partnerships to share resources; or introduced in as a pilot or broader systemic implementation using blended funding models and service agreements. Hospital substitution and avoidance models need to be accompanied by an appropriate reimbursement model for health professionals and a supported and skilled workforce.    

UnitingCare Queensland Position 

UnitingCare Queensland considers that a greater range of clients can benefit from hospital substitution and avoidance models and is committed to working in partnership with the Queensland Government and acute and primary health care providers to identify and implement suitable opportunities. One immediate opportunity is a trial of Hospital in the Home services involving telehealth and remote monitoring delivered to a wider patient cohort.  

References
  • Economic analysis of Hospital in the Home (HITH), Hospital in the Home Society of Australasia, Deloitte Access Economics 2011
  • A meta-analysis of “hospital in the home”, Caplan, G, Sulaiman, N et al, Med J Aust 2012; 197 (9): 512-519.



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