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Clustered domestic residential aged care in Australia: fewer hospitalisations and better quality of life.

Dyer, Suzanne M; Liu, Enwu; Gnanamanickam, Emmanuel S; Milte, Rachel; Easton, Tiffany; Harrison, Stephanie L; Bradley, Clare E; Ratcliffe, Julie; Crotty, Maria.
Med J Aust; 208(10): 433-438, 2018 Jun 04.
Artigo em Inglês | MEDLINE | ID: mdl-29848247

OBJECTIVE:

To compare the outcomes and costs of clustered domestic and standard Australian models of residential aged care.

DESIGN:

Cross-sectional retrospective analysis of linked health service data, January 2015 - February 2016.SETTING: 17 aged care facilities in four Australian states providing clustered (four) or standard Australian (13) models of residential aged care.PARTICIPANTS: People with or without cognitive impairment residing in a residential aged care facility (RACF) for at least 12 months, not in palliative care, with a family member willing to participate on their behalf if required. 901 residents were eligible; 541 consented to participation (24% self-consent, 76% proxy consent).

MAIN OUTCOME MEASURES:

Quality of life (measured with EQ-5D-5L); medical service use; health and residential care costs.

RESULTS:

After adjusting for patient- and facility-level factors, individuals residing in clustered models of care had better quality of life (adjusted mean EQ-5D-5L score difference, 0.107; 95% CI, 0.028-0.186; P = 0.008), lower hospitalisation rates (adjusted rate ratio, 0.32; 95% CI, 0.13-0.79; P = 0.010), and lower emergency department presentation rates (adjusted rate ratio, 0.27; 95% CI, 0.14-0.53; P < 0.001) than residents of standard care facilities. Unadjusted facility running costs were similar for the two models, but, after adjusting for resident- and facility-related factors, it was estimated that overall there is a saving of $12 962 (2016 values; 95% CI, $11 092-14 831) per person per year in residential care costs.

CONCLUSIONS:

Clustered domestic models of residential care are associated with better quality of life and fewer hospitalisations for residents, without increasing whole of system costs.