Reducing avoidable hospital admissions of the frail elderly using intelligent referrals

Abstract

From around 50 years of age, the utilisation of hospital services begins to spiral upwards. In Australia patients over 65 years account for 46% of acute hospital bed days and 33% of hospital separations, although they represent only 12% of the total population. By 2051 the percentage of over-65s in the Australian population is projected to double. The largest increase will be in the over-85 group from 1% in 2002 to between 6 and 9% by 2051; a massive 500-700% increase. This cohort is more likely to experience frailty and their increase in the population is expected to impact demands for and the cost of providing health services. There are expected to be similar changes in the populations of most developed countries and addressing the challenges of ageing and aged care is now a high priority of many governments. Aged patients commonly present to hospitals with multiple, complex conditions and tend to be admitted because clinicians have insufficient time to explore other options and the patient’s suitability for these. Around developed countries there is interest in strategies to reduce demand on hospitals by providing healthcare for the aged and chronic ill in homes and community settings. There is a paucity of research about effective ways to achieve this. Home care is expected to be a less costly alternative to institutional care and is often preferred by patients. This paper reports on an evaluation of an approach to reducing avoidable hospital admissions of the frail elderly through information technology. It involved a real-time assessment tool, an intelligent agent to identify candidates for assessment, and referrals to home-care providers assisted by electronic transfer of information.