Bird Stephen, Noronha Michelle, Sinnott Helen
Health Innovations Research Institute and School of Medical Sciences, RMIT University, PO Box 71, Bundoora, Vic. 3083, Australia.
Aust J Prim Health. 2010;16(4):326-33. doi: 10.1071/PY10007.
As part of the Department of Human Services Hospital Admissions Risk Program (HARP), a group of acute and community based health care providers located in the western suburbs of Melbourne formed a consortium to reduce the demand on hospital emergency services and improve health outcomes for patients with chronic obstructive pulmonary disease (COPD) and chronic heart failure (CHF). The model of care was designed by a team of multidisciplinary specialists and medical consultants. In addition to receiving normal care, patients recruited to the project were assessed by 'Care Facilitators', who identified unmet health care needs and provided information, advice and education for the patient concerning their condition and self-management. Patients declining recruitment received all normal care services. The patients' rates of emergency department (ED) presentations, inpatient admissions and hospital inpatient bed-days before and after their recruitment were calculated from the Western Health patient activity records, and pre- versus post-recruitment rates were compared using ANOVA. Changes relative to the ongoing use by those who declined recruitment were compared using the group-by-time interaction. Patient health outcomes were assessed using established disease-specific tools, and pre- versus post-recruitment values were compared using paired t-tests. Patients recruited to the COPD project reduced (P<0.05) their emergency presentations, admissions and hospital inpatient bed-days by 10, 25 and 18%, respectively, whereas those declining recruitment increased their usage by 45, 41 and 51% respectively. Recruited CHF patients also displayed reductions in emergency presentations (39%), admissions (36%) and hospital inpatient bed-days (33%), whereas those who declined recruitment displayed lesser reductions for ED presentations (26%) and admissions (20%), and increased their use of hospital inpatient bed-days (15%). The recruited COPD patients reported a significant reduction in their symptoms (P<0.005) and the CHF patients reported an improvement in their overall health and quality of life scores (P<0.001). The outcome measures used in this evaluation suggest that an integrated care facilitation model that is patient focussed, provides an education component to promote greater self-management compliance and delivers a continuum of care through the acute and community health sectors, may reduce the utilisation of acute health care facilities and benefit the patient.
作为公共服务部医院入院风险项目（HARP）的一部分，位于墨尔本西郊的一群急症和社区医疗服务提供者组成了一个联盟，以减少对医院急诊服务的需求，并改善慢性阻塞性肺疾病（COPD）和慢性心力衰竭（CHF）患者的健康状况。护理模式由一组多学科专家和医学顾问设计。除了接受常规护理外，招募到该项目中的患者由“护理协调员”进行评估，护理协调员会确定未满足的医疗需求，并就患者的病情和自我管理为其提供信息、建议和教育。拒绝参与招募的患者接受所有常规护理服务。根据西部健康医疗患者活动记录计算患者在参与招募前后的急诊科就诊率、住院率和住院天数，并使用方差分析比较招募前后的比率。使用组间时间交互作用比较与拒绝招募者持续使用情况相关的变化。使用既定的特定疾病工具评估患者的健康状况，并使用配对t检验比较招募前后的值。参与COPD项目的患者将其急诊就诊、住院和住院天数分别减少了10%、25%和18%（P<0.05），而拒绝招募的患者分别将其使用率提高了45%、41%和51%。参与招募的CHF患者在急诊就诊（39%）、住院（36%）和住院天数（33%）方面也出现了下降，而拒绝招募的患者在急诊就诊（26%）和住院（20%）方面的下降幅度较小，且住院天数使用增加（15%）。参与招募的COPD患者报告其症状显著减轻（P<0.005），CHF患者报告其整体健康和生活质量得分有所改善（P<0.001）。本次评估中使用的结果指标表明，以患者为中心的综合护理协调模式，提供教育成分以促进更高的自我管理依从性，并通过急症和社区卫生部门提供连续护理，可能会减少急性医疗设施的使用并使患者受益。
