Abstract
Objective
In parts of Australia, Residential In-Reach (RIR) services have been implemented to
treat residential aged care (RAC) residents for acute conditions in their place of
residence to avoid preventable hospital presentation. Our service was initiated in
2009 and restructured in 2014. We compared acute healthcare resource utilization (RIR
activity and emergency hospital presentations) by RAC residents under 2 RIR models
of care.
Design
Acute RAC RIR service model of care was changed from existing nurse/emergency physician-led
service to nurse/geriatrician-led service and incorporate inpatient liaison nurse
consultant into the team.
Setting
RAC episodes and hospital presentations from a single tertiary referral hospital and
its associated RAC RIR service.
Methods
Retrospective audit comparing RIR activity, hospital presentations, and associated
costs from 2 12-month periods, prior to and postimplementation. Data were expressed
as a proportion of the total number of RAC beds in the hospital RIR catchment.
Results
After implementation of the new model of care, RIR episodes of care increased from
589 to 985 (15.3 vs 24.7 episodes/100 RAC beds, P < .001). Emergency department (ED) presentations fell from 1616 to 1478 (41.9 vs
37.2 presentations/100 RAC beds, P < .001). There were fewer unplanned ED presentations by RIR patients (2.4% vs 0.8%, = 0.03)
and fewer 28-day ED re-presentations (16.8% vs 13.7%, P = .01) under the new model of care. ED cost [$AUD 30,830 vs $28,030/100 RAC beds
($USD 21,344 vs $19,407), P < .001] and inpatient admission costs [$145,607 vs $117,531/100 RAC beds ($USD 100,814
vs $81,380), P < .001] were each lower in the second period.
Conclusions and Implications
In the 12 months following implementation of the new model of care, an increase in
RIR activity, and a decrease in ED presentations was observed. Further research is
necessary to validate these retrospective findings and better evaluate clinical outcomes
and consumer satisfaction of the service.
Keywords
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Article info
Publication history
Published online: September 11, 2020
Footnotes
The authors declare no conflicts of interest and there was no grant/funding source.
Identification
Copyright
© 2020 AMDA - The Society for Post-Acute and Long-Term Care Medicine.
