Aims and objectives: To undertake an outcomes evaluation of a Hospital in the Nursing Home (HINH) admission avoidance programme.
Background: Admission avoidance type services such as Hospital in the Home have a place in improving service delivery for certain population groups. Research related to HINH has been limited, derived from various different health care systems internationally and results are varied.
Design: A quasi-experimental study was conducted at one regional hospital. Routinely collected health information system data from two separate data sources were linked to undertake analysis.
Methods: Those in the intervention group were matched to a comparison group of patients on the basis of three characteristics (age, gender and diagnostic category). Other factors that could affect a patient's hospital outcomes and length of stay (LOS) were statistically controlled for. Participants were aged care facility residents enrolled in a HINH programme (n = 62) and a matched group receiving usual in-hospital care (n = 115). Emergency department (ED) outcome measures included LOS and re-presentation. Hospital admission-related outcome measures included episode of care LOS, in-hospital LOS and hospital readmission.
Results: A significant independent relationship between HINH programme enrolment and shorter in-hospital LOS was identified even after adjusting for other characteristics OR 0·16 (95% CI 0·28, 0·99 p < 0·001).
Conclusion: The HINH model evaluated, with its focus on delivering acute care for aged care facility residents, can impact on health service delivery.
Relevance to clinical practice: With a demonstrated reduction in in-hospital LOS, the available bed space created can be used for other patients perhaps waiting in the ED or waiting for surgery.
© 2010 Blackwell Publishing Ltd.