Health service utilisation and health outcomes of residential aged care residents referred to a hospital avoidance program: A multi-site retrospective quasi-experimental study.

OBJECTIVE: To compare the health system utilisation patterns and health outcomes of residential aged care facility (RACF) residents reviewed by a hospital avoidance program to those of RACF residents who received usual care. METHODS: A retrospective evaluation of a hospital avoidance program provided by a hospital-based medical and nursing outreach team. Residents reviewed by the program were randomly matched 1:1 to comparison group residents based on age group, sex and number of co-morbidities. Number of hospital admissions, excess hospital length of stay and excess hospital treatment costs were compared. RESULTS: Residents reviewed by the program spent an average 9-10 days fewer in hospital with AUD$2,091 to $8,014 lower hospital treatment costs compared to comparison group residents. CONCLUSION: Rapid provision of outreach services for the management of acute care of RACF residents may reduce the number of days residents spend in hospital, as well as reducing the associated hospital treatment costs.

Comparison of health service use trajectories of residential aged care residents reviewed by a hospital avoidance program versus usual care.

OBJECTIVE: To compare health service use trajectories of residential aged care facility (RACF) residents reviewed by the Aged Care Rapid Response Team (ARRT) to RACF residents who received usual care. METHODS: A retrospective group-based trajectory analysis of RACF residents aged ≥65 years who were reviewed by ARRT during 1 July 2015 to 30 June 2016 was conducted. Health service use trajectories were followed for two years to 30 June 2018 and compared to RACF residents aged ≥65 years who lived in the same Local Health District and received usual care. RESULTS: There were 2,245 ARRT-reviewed resident hospitalisations and 11,892 usual care resident hospital admissions during 2015-16. Trajectory analysis categorised ARRT-reviewed residents into four groups and usual care residents into three groups. Age, comorbid health conditions and dementia were predictors of group membership in both ARRT-reviewed RACF residents and usual care RACF residents. Additionally, gender predicted group membership in ARRT-reviewed RACF residents and fall-related injuries predicted group membership in usual care RACF residents. CONCLUSION: The identification of health service use trajectories assists in understanding hospital use by older RACF residents and may offer guidance in the design of prevention measures, including hospital avoidance programs.

The safety of pelvic surgery in the morbidly obese with and without combined panniculectomy: a comparison of results.

PURPOSE: The purpose of our study was to evaluate the benefit of panniculectomy combined with pelvic surgery in the morbidly obese patient. Previous literature has found this combined procedure in this particular patient population to have increased morbidity and that it was not beneficial. METHODS: A chart review was performed an all patients who underwent pelvic surgery with or without a panniculectomy between June 2004 and June 2005. Only morbidly obese patients (body mass index of >40 kg/m2) were included in the study. Factors evaluated were operative times, intraoperative blood loss, weight of pannus resection specimen, length of hospital stay, wound infection rate, and other complications. All data were analyzed using Levene test for equality of variances and the t test for the equality of means. RESULTS: Thirty-six patients had combined panniculectomy and abdominal hysterectomy, 14 had an abdominal hysterectomy without a panniculectomy. The mean operative times for the combined procedure was 3.4 hours versus 2.6 hours without panniculectomy. The mean estimated blood loss was 526 mL for the combined procedure (CP) and 536 mL for hysterectomy alone (HA). There were 2 wound infections in the CP group (5.6%) versus 3 in the HA group (21.4%). There was one wound dehiscence in the CP group (2.8%) and one in the HA group (7.1%). There was one inadvertent enterotomy in the HA group (7.1%) and none in the CP group. There were no statistical differences noted for any variable including patient body mass index, mean operative time, estimated blood loss, or rate of complications. CONCLUSIONS: Our findings, in contrast to previous findings, reveal that panniculectomy combined with pelvic surgery in the morbidly obese is a safe procedure that can decrease the incidence of intraoperative complications and postoperative wound complications without significantly increasing operative time or blood loss.