Archived 9 May 2003 - some links may not work
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Service Sustainability Projects (1998-99)
Health Care Networks and non-network metropolitan hospitals were offered
one-off funding, to review their current systems, to establish more effective
and efficient service models, undertake local costing analyses and develop
medium and long term strategies for the continuation of HITH services
beyond 1999-2000. While direct government incentive funding for the HITH
Program is due to expire on 1 July 2000, the government is committed to
the continuation of home based acute care as a mainstream option for all
Victorians admitted to hospital.
Key issues and findings of the Service Sustainability projects:
- Service models developed for delivery of HITH in Victoria provide
the basis for a viable financial alternative to inpatient care for certain
medical and post-surgical conditions.
- It was confirmed that HITH programs make an effective contribution
toward cost minimisation of acute hospital services, and, although only
a small part of overall services, enable increased throughput at lower
cost.
- HITH care is a safe model of delivery, given the reportedly low incidence
of adverse events for HITH patients.
- Many projects identified a trend towards a longer length of stay for
non-same-day HITH episodes compared with overall hospital and State
length of stay for comparative DRGs.
- Surveys indicated a high level of client/carer satisfaction with HITH,
a high level of regard by key stakeholders and a high degree of job
satisfaction by nursing staff.
- Data entry and discharge coding practices can impact both risk management
and revenue collection.
- Collection of patient outcome data, other than anecdotal evidence,
is lacking, and that of clinical indicator data is limited or inconsistent.
- Some identified the need to raise the profile of the HITH program
among medical consultants, promote its multidisciplinary aspects and
improve communications between professionals; others raised the need
to improve the process of clinical review by medical staff, in particular
the issue of patient review when the patient is at home.
Click here for a Summary Report on the findings
of Service Sustainability projects (PDF file 73KB)
Hospital in the Home Service Audit (1998-99)
During 1998-99, KPMG Consulting Pty Ltd conducted a service audit of
all hospitals participating in the HITH Program. One of the main aims
of the audit was to provide independent feedback to hospitals to assist
them in quality improvement.
KPMG found marked improvement of hospital performance from the previous
audit (1996 -97) in relation to:
- patient eligibility;
- project documentation and quality processes;
- patient care protocols and management;
- emergency back-up and protocols; and
- patient recording.
Click here for KPMG's Final report on the HITH
Service Audit (PDF file 470KB)
Costing Study
The Department contracted the North Western Health Care Network to conduct
a costing study of the HITH Program, with the following aims:
- To make a definitive assessment of the extent to which HITH care can
be provided within existing casemix funding by the financial year 2000-2001.
- To identify costs associated with the provision of home based care
as compared with hospital based care.
- To recommend ways to facilitate the long term viability of HITH care.
Key Findings
- Hospital in the Home is a safe, acceptable and cost-effective
alternative to acute in-hospital care for a wide range of clinical
conditions.
- The HITH cost comparison exercise demonstrates that overall the
HITH Program can be delivered within the existing casemix funding
system.
- Overall HITH is significantly cheaper than its matched non-HITH
(in-hospital) care and average daily costs are cheaper for both
"mixed" and "pure" HITH.
- For pure HITH (total episode substitution), HITH care is cheaper
than in-hospital care across all sites and conditions.
- Length of stay (LOS) is shorter or the same for pure HITH compared
with non-HITH.
- The total episode LOS for mixed HITH is greater than for its matched
in-hospital episode. This is due to longer in-hospital LOS prior
to transfer to HITH.
- Mixed HITH total episode cost is not significantly different than
non-HITH after adjustment for potential confounders. The strongest
confounder is LOS.
- Chemotherapy, cellulitis, respiratory conditions, venous thrombosis,
kidney or urinary tract infections, and less complex post surgical
conditions were consistently cheaper to provide in HITH than in-hospital
across all sites. Savings in infrastructure related costs are likely
explanations for the savings in nursing and medical costs.
Summary Report of Costing
Study (PDF file 196KB)
Victorian Centre for Ambulatory Care Innovation (Now Called Ambulatory
Care Australia)
The Department agreed to provide seeding funding over a three-year period
from 1997-98 for the establishment and maintenance of an industry resource
centre, the Victorian Centre for Ambulatory Care Innovation (VCACI), an
organisation which promotes clinical research and the development, trialing
and evaluation of HITH-type initiatives. The VCACI also provides information
and advice on the latest developments in the field of home based care
to hospitals participating in the HITH Program.
For more information, see the Ambulatory
Care Australia Web site
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