Integrated care facilitation model reduces use of hospital resources by patients with pediatric asthma.

This evaluation assessed a model of care for pediatric asthma patients that aimed to promote health and reduce their preventable and avoidable use of acute hospital services. Pediatric asthma patients (n=223) were allocated care facilitators who provided assistance in the promotion of carer/self-management, education and linkage to an integrated healthcare system, comprising of acute and community-based healthcare providers. Patients' use of acute hospital services (emergency department [ED] presentations, admissions, and bed-days) pre- and postrecruitment were compared using Wilcoxon signed rank tests. The pediatric asthma care givers quality of life questionnaire' was used to assess changes in health and quality of life. The patients displayed a 57% reduction in ED presentations, 74% in admissions, and a 71% reduction in bed-days. Whereas a comparator group displayed 27%, 32%, and 14% increases, respectively. Patients also reported significant improvements in quality of life domains of activity limitation (+5.6, p<.001) and emotional function (+9.1, p<.001). The reduction in the use of hospital services was attributed to the aversion of preventable presentations and admissions, via the enhancement of carer/self-management and access to community health services. These outcomes were supported by indicators of improved patient health and quality of life, and comments by the participant's carers.

An integrated care facilitation model improves quality of life and reduces use of hospital resources by patients with chronic obstructive pulmonary disease and chronic heart failure.

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.