Proactive primary care model for frail older people in New Zealand delays aged-residential care: A quasi-experiment.

BACKGROUND/OBJECTIVES: To determine the effect of a proactive primary care program on acute hospitalization and aged-residential care placement for frail older people. DESIGN: Controlled before and after, and controlled after only quasi-experimental studies, with a comparison group created via propensity score matching. One-year follow-up. SETTING: Nine general practices in Auckland, New Zealand. PARTICIPANTS: Community-dwelling people aged 75 and older identified as at increased risk of hospitalization. One thousand and eighty five patients are compared with 3750 comparison patients matched by propensity score based on known risks. INTERVENTION: Primary healthcare based, registered nurse-led, comprehensive geriatric assessment, goal-setting, care planning, and regular follow-up. Patients were also provided self-management education, health and social care navigation, and transitional care for hospital discharges. Practices received program support, workforce development, and mentoring of primary healthcare nurses by gerontology nurse specialists. MEASUREMENTS: Outcomes from routinely collected administrative data. Primary: aged-residential care placement. SECONDARY OUTCOMES: acute hospitalization, mortality, and other health service utilization. RESULTS: Aged-residential care placement (odds ratio [OR] 0.66, 95% confidence interval (CI) = 0.48-0.91) and mortality (OR 0.66, 95% CI = 0.49-0.88) were significantly lower over the first year in Kare patients compared with matched controls. There was no difference in acute hospitalization (+0.06 admissions per year, 95% CI = -0.01-0.13). Support service use (allied health therapists and assessment for social support) was increased, and emergency department use decreased. CONCLUSION: The Kare participants had lower aged-residential care placement and mortality in the first year, but no decrease in acute hospitalization. Because the design is nonexperimental caution is required in interpreting these results.

Pathways to ambulatory sensitive hospitalisations for Maori in the Auckland and Waitemata regions.

AIM: Ambulatory Sensitive Hospitalisations (ASH) are a group of conditions potentially preventable through interventions delivered in the primary health care setting. ASH rates are consistently higher for Maori compared with non-Maori. This study aimed to establish Maori experience of factors driving the use of hospital services for ASH conditions, including barriers to accessing primary care. METHOD: A telephone questionnaire exploring pathways to ASH was administered to Maori (n=150) admitted to Auckland and Waitemata District Health Board (DHB) hospitals with an ASH condition between January 1st-June 30th 2015. RESULTS: A cohort of 1,013 participants were identified; 842 (83.1%) were unable to be contacted. Of the 171 people contactable, 150 agreed to participate, giving an overall response rate of 14.8% and response rate of contactable patients of 87.7%. Results demonstrated high rates of self-reported enrolment, utilisation and preference for primary care. Many participants demonstrated appropriate health seeking behaviour and accurate recall of diagnoses. While financial barriers to accessing primary care were reported, non-financial barriers including lack of after-hours provision (12.6% adults, 37.7% children), appointment availability (7.4% adults, 17.0% children) and lack of transport (13.7% adults, 20.8% children) also featured in participant responses. CONCLUSIONS: Interventions to reduce Maori ASH include: timely access to primary care through electronic communications, increased appointment availability, extended opening hours, low cost after-hours care and consistent best management of ASH conditions in general practice through clinical pathways. Facilitated enrolment of ASH patients with no general practitioner could also reduce ASH. Research into transport barriers and enablers for Maori accessing primary care is required to support future interventions.

The excess cost associated with healthcare-associated bloodstream infections at Auckland City Hospital.

AIM: This study was undertaken to determine the cost of healthcare-associated bloodstream infections (HA-BSI) in adult patients admitted to an Auckland City Hospital. METHOD: A matched cohort study was performed with a 1:2 or 1:1 match in which all patients admitted between January and June 2005 who had HA-BSI were included. Controls were selected from patients admitted between July 2004 and December 2006. Patients with haemodialysis central line-related HA-BSI were not matched with controls as the admission was related purely to that episode of infection. RESULTS: There were 106 episodes of HA-BSI in 99 patients. Fifty-five patients were able to be matched 1:1 or 1:2 with controls, group 1. Nineteen BSI episodes were in patients undergoing renal replacement therapy by haemodialysis and the patients were admitted as a consequence of this episode of infection, group 2. An episode of HA-BSI increased the length of the hospital admission by 9.7 days and 7.9 days in group 1 and group 2, respectively. The excess cost associated with an episode of HA- BSI was $20,394 in group 1 and $11,139 in group 2. CONCLUSION: There are substantial costs associated with HA-BSI. A proportion of these infections can be reduced by effective infection control measures.