Victoria's Hospital in the Home Program

www.health.vic.gov.au/hith

Archived 9 May 2003 - some links may not work

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Service Development Projects

1997-98 Projects

The Department offered grant funding in 1997-98, on a competitive basis, to Networks and hospitals for research and development, with the aim of encouraging wider use of home based acute care. The following projects were successful in attracting funds. For further information on individual projects, please click on those headings which are underlined. More information will be added as it becomes available.

1. Barwon Health: General Practitioner (GP) Education (PDF file 13KB)
With the aim of improving GP participation in HITH care, an education program to GPs in the Barwon Region was developed and delivered following a process of consultation between the Geelong Division of GPs and the Geelong Hospital consultant medical and HITH nursing staff. In parallel with this, GPs were surveyed by questionnaire to identify issues around HITH care.

2. Barwon Health: Nurse Exchange Program
This project was designed to update or develop key nursing competencies required to provide safe and effective acute nursing care in the home setting. It was implemented by means of over eighty days of exchanges between community based and acute care nurses, who experienced opportunities to directly observe and practise the skills required.

3. Wodonga Regional Health Service: Growth and development of HITH (PDF file 7KB)

• Extension into evening and weekend hours, using dedicated HITH staff.
• Expansion into Continuous Ambulatory Peritoneal Dialysis (CAPD).
• Expansion into Chemotherapy treatments.
• Expansion into Paediatrics.
  

• Children with cystic fibrosis.
• Children diagnosed with febrile neutropenia.
• Children who require an overnight oximetry test.

5. Royal Melbourne Hospital: A. Shared Care Protocols; B. The role of the HITH nurse

A. Shared Care Protocols
This part of the project aimed to maximise utilisation of HITH for suitable conditions, by developing:

• New treatment and shared care protocols for home based acute care.
• The general practitioner's role in home based acute care.
• Closer working relationships between GPs and hospital staff.

B. The role of the HITH nurse (PDF file 13KB)
By means of focus groups and in depth interviews with key HITH stakeholders, this qualitative study sought to identify and explore the range of issues faced by the nursing profession in providing home based acute care in the context of a changing health system. The exercise revealed much that may inform the future development of the unique role and training requirements of the Victorian HITH nurse.

6. Western Hospital: Development of strategies to improve access and service responsiveness of the HITH Program for patients from culturally and linguistically diverse communities (PDF file 9KB)

The project was resourced from Western Hospital but involved all HITH programs in North Western Health: those at the Northern, Royal Melbourne, Werribee Mercy, Western and Williamstown Hospitals. The project was conducted in two stages.

Stage 1: The Centre for Culture, Ethnicity and Health was engaged to undertake a service review of the above HITH programs, in order to understand the extent to which the programs were relevant to and met the needs of people from diverse linguistic and cultural backgrounds. The resulting recommendations formed the basis for Stage 2.

Stage 2: A range of activities was undertaken, including the development of cultural diversity policy documents and protocols; training sessions for staff and management; the development of information packages, documents and other materials in three selected languages; and the conduct of a local media campaign targeting these community language groups.

7. The Alfred: Establishment of Carer Training Centre
This Centre was established to identify and address the formerly ill-defined needs of carers of HITH patients, including needs in the areas of information, support, communication and impact on lifestyle. Action resulting from the initial study includes the development of education materials in different formats.

8. Frankston Hospital: Development and testing of clinical indicators for HITH care

There were three main aspects to this project:

• to develop and pilot clinical indicators for HITH, using an appropriate methodology;
• to investigate and validate the use of a Case Load Index; and
• to examine the quality of HITH care delivered in ten HITH sites in Victoria, through an examination of their clinical indicator outcomes data.

A publication including a peer review of this project has been listed on Medline: Montalto M, Portelli R, Collopy B: Measuring the quality of hospital in the home care: a clinical indicator approach, International Journal of Quality in Health Care 1999; 11 (5): 413-418.

9. Frankston Hospital: Method of measuring the cost of HITH care: a secondary analysis

In the context of making cost comparisons between home based acute care and traditional hospital care, a small scale secondary costing study was performed on one condition (cellulitis) managed in the home setting and that of Frankston Hospital.

10. Monash Medical Centre: Assessment of a portable INR (International Normalised Ratio) instrument for monitoring of anticoagulation

This two-phase study aimed to evaluate the validity of the Portable INR (International Normalised Ratio) instrument for the monitoring of Warfarin therapy and to improve the response time for the dosing of Warfarin by bringing the test to the patient in their home environment.

11. Monash Medical Centre: Assessment of the rate of complication of PIC (Peripherally Inserted Central) catheters (PDF 24KB)

This project aimed to establish an Australasian Network of health care units that regularly use PIC catheters, to undertake a prospective audit of the rate of complication associated with these devices over an 18-24 month period, and to assess any association between reported complications and clinical factors.

12. Monash Medical Centre: Development of Victorian disease specific guidelines for HITH (PDF File 45KB)

This project involved the conduct of a retrospective and prospective study of disease specific outcomes in four HITH units, the development of guidelines for those medical conditions suitable for HITH treatment and the identification of conditions which, from clinical and financial perspectives, are not suitable for HITH treatment.

13. Monash Medical Centre: Early discharge into HITH for low risk patients with uncomplicated AMI (Acute Myocardial Infarction) (PDF file 7KB)

This two pronged research study explored the experiences of patients with AMI who entered the HITH program and the carers at home with these patients. Demographic trends of patient and carer groups were explored and their educational needs at three time points were identified, examining links between coping, stress and burden of care within those time points.

1998-99 Projects

The following projects attracted funds in 1998-99. The majority of projects are currently being undertaken, and final reports will be available on this web site as they become available.

1. South West Healthcare (Warrnambool): Nurse Liaison

This project is designed to improve referral processes and communication with clinicians.

2. Goulburn Valley Health: Improving access to HITH with a focus on Koori consumers and those from culturally and linguistically diverse backgrounds

The aims of this project are:
* to develop a service culturally sensitive and accessible to the Koori community;
* to develop multi lingual capabilities of health professionals;
* to provide training to HITH nurses and GPs; and
* to improve communication and continuity of care.

3. North Western Health Care Network: Establishment of a HITH service at Broadmeadows Health Service and development of sustainable service links

This project was discontinued due to difficulties in establishing HITH services at a new Integrated Care Facility.

4. Royal Children's Hospital: Establishment of a statewide paediatric HITH network

This project seeks to incorporate HITH care into the existing statewide framework for paediatric nursing services, to develop a statewide paediatric HITH network and to increase the utilisation of HITH services by metropolitan and rural paediatric services.

5. Inner & Eastern Health Care Network (The Angliss Health Services and Peter MacCallum Cancer Institute): Establishment of an oncology consultative service at The Angliss

The Peter MacCullum Cancer Institute is the service provider for the Angliss Health Services, in order to establish a high quality oncology service in the Ferntree Gully region, with HITH as a key focus, and treatment with chemotherapy via a HITH program.

6. Peninsula Health Care Network (Frankston Hospital): Diabetes at home: Development of a home insulin initiation and stabilisation program and guidelines

The aims of this project are to:

• Determine usual practice for delivery of diabetic stabilisation in HITH units;
• Establish and validate appropriate protocols for management and support requirements for insulin initiation at home; and
• Establish a Diabetes Stabilisation Unit and evaluate the service.
  

7. Southern Health Care Network (Monash Medical Centre): Development of a Monash-Gippsland HITH collaborative network (PDF 28KB)

This project has as its objectives to:

• Establish a collaborative HITH Network model involving HITH programs conducted by the Southern Health Care Network, Gippsland Southern Health Service, West Gippsland Healthcare Group and Wonthaggi and District Hospital.
• Provide professional and educational support to the HITH network.
• Improve continuity of care.
• Develop links with medical practitioners.

8. Southern Health Care Network (Monash Medical Centre): Randomised double-blind trial for HITH treatment of cellulitis

The three aspects of this project are to:

• Conduct a multi-site study of cefazolin vs ceftriaxone in patients with cellulitits treated via HITH;
• Measure serum concentrations of cefazolin and ceftriaxone; and
• Assess the comparative costs and applicability of the regime to other programs.