Report on 2001-2002, Post Acute Care Program - Department of Human Services Victoria Australia

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Post Acute Care Program

Report on 2001-2002

Published: August 2003

Introduction

Post Acute Care is a time limited short term intervention designed to assist patients to recuperate following an admission to a public hospital (acute and sub-acute), to facilitate independence or transition to continuing care where required, and to prevent the need for admission to in-patient services. Patients receive individually tailored packages of services from the PAC Service that covers their area of residence.

Eighteen PAC Services provide state-wide coverage. They have a flexible pool of funds from which to purchase and co-ordinate community services to support patients, such as home nursing, home help, personal care, child care, physiotherapy and other allied health services.

During 2000-2001, the PAC Program expanded to include eligible patients discharged from an episode of sub-acute care. The Program also expanded to include patients presenting to Emergency Departments, where clinically appropriate. This expansion took place late in the 2000-2001 financial year, and the effects of it were more fully seen in 2001-2002.

This report includes a number of charts covering many aspects of the operation of the Program and providing, in most cases, comparisons with activity in 2000-2001.

Client Profile (Charts 1 to 6)

The Post Acute Care Program has shown increasing levels of activity, measured in completed client episodes, since its inception in 1996-1997. In 2001-2002, a total of 32,150 clients received services, which represented 42% more PAC episodes completed than in the previous year. In general, PAC Services exceeded their client targets by 12% in 2001-2002.

Female clients represented approximately 70% of the State total and males approximately 30%, although these proportions varied by up to 14% either way in some PAC Services. The exception to this was the Royal Children’s Hospital PAC Service, where proportions were closer to being equal.

The group of clients over 75 years of age remains the largest age group at 33% of all PAC clients, but only 15% of the overall public hospital separations. Clients over 75 years constituted half of all PAC clients who were referred from an ED in 2001-2002.

Services purchased by Post Acute Care (Chart 7)

During 2001-2002, the cost of purchasing post acute care services across the Program in Victoria amounted to $10 million. The most significant items of expenditure in purchased services, representing 84% of the total purchased service provision, were home care, nursing, personal care, delivered meals and physiotherapy. While nursing care and physiotherapy are higher cost services, this does not necessarily equate to the most frequently used services.

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Client Outcomes (Chart 8)

The majority of clients (45%) required no further services following their discharge from PAC and returned to total independence. Slightly more than one quarter upon discharge from PAC required higher levels of community-based services than before hospital admission. A small number were readmitted to hospital. Similarly, a small number returned to pre-admission levels of community support.

Length of Stay (Charts 9 and 10)

For several years, the average number of days spent by PAC clients on the PAC Program remained at 23 days. In 2000-2001 and 2001-2002, this increased to 25 days. Average lengths of stay varied in individual PAC Services from 16 to over 35 days for acute clients.

Days are counted from the date services officially commence. With the expansion to include patients presenting to an Emergency Department and those discharged from a sub-acute service, the variations were greater. The average length of stay in 2001-2002 was 28 days for sub-acute clients, and 23.5 days for Emergency Department clients.

Readmission Rates (Charts 11 and 12)

The average proportion of clients returning to acute care at the end of a PAC episode remained at 10% again in 2001-2002. The proportions in the various PAC Services varied widely between 1% and 20%. The highest readmission rates in 2001-2002 were for clients who had presented to an Emergency Department (average rate of 11%). The lowest rates were for sub-acute clients (average of 8.1%). Readmission may relate to the age, chronicity and/or complexity of clients, rather than the quality of service provided by PAC.

Cost of providing PAC services (Charts 13 to 15)

The average cost of purchasing services for each client in 2001-2002 increased to $287 from $254 in the previous year and varied according to the category of client. Generally, more was spent on Emergency Department clients (($295) than on clients discharged from acute inpatient services ($279). The cost of purchased services for sub-acute clients averaged $370. However, services purchased for patients discharged from the Royal Children’s Hospital were significantly higher, due to the special needs of those clients (average of $712).

On the other hand, the average overall case cost, including purchased services, care coordination and infrastructure, increased from $534 in 2000-2001 to $574 in 2001-2002. This increase can be partly attributed to the increase in price of purchased services.

Maintenance of Effort (Charts 16 and 17)

When clients receive services prior to admission to hospital, it is expected that, during and following the post acute period, the relevant service providers will maintain these services at the prior levels. This is referred to as “maintenance of effort”. While there is no charge to the PAC Program for these services, they are co-ordinated by the Program as part of the package of care. During 2001-2002, 92.4% of services ($9.24 million) were provided from program funds and 7.6% of services ($0.76 million) were provided from maintenance of effort. The amount reported as being provided through maintenance of effort has been decreasing over the last few years.

PAC Referrals reported on the Victorian Admitted Episodes Dataset (VAED) (Charts 18 to 24)

Referrals to Post Acute Care generally take place prior to discharge from an acute or sub-acute service, and are recorded on the hospital’s database as a “P code”. A variety of people may refer patients to PAC, and there are some “community referrals” (patients who have been referred shortly after returning home from hospital) and as a result, the VAED has not proved a particularly reliable or accurate source of information about the precise numbers of referrals to Post Acute Care.

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Charts

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PAC referrals reported on VAED as percentage of total hospital separations for the following hospital groups:

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Last updated: 14 August, 2009
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