Hospital in the Home version 5

HOSPITAL IN THE HOMEHOSPITAL IN THE HOME

GENERAL COMMENTS

Dr Michael Montalto Hospital in the Home Society Australasia

New services need new ways of demonstrating quality. Hospital in the Home (HITH) has been in existence in Australian hospitals for over 20 years. While that probably no longer qualifies it as 'new' in the common use of the term, in terms of hospital clinical specialties, it remains new. In 2019, Hospital in the Home held its first international conference, itself arguably an indicator of professional and organisational development.

Research into the links between structure, process and outcomes continue in our emerging field. In this regard, the ACHS Clinical Indicators have been leading the development of quality measures, rather than resulting from them. We expect, and indeed hope, that as more work on outcomes is published in this field, these indicators will be validated, refined and modified. But for now, they remain a common language with which units and hospitals can discuss their work. There are always variables that a sensible reader ought to consider. It must be acknowledged that HITH still remains a tapestry of models, staffing, coverage, patient severity and clinical scope. The major variables that might affect the collection and interpretation of these indicators are HITH units that: do not operate 24 hours; use third party providers; do not provide a full suite of hospital clinical services and therefore have a lower clinical severity profile to match.

Over the next decade, the emphasis on hospital substitution and acute home based care will grow. These indicators are recommended to those who want to enter this field, or wish to expand, as useful markers of quality to assist that growth and development.

FEATURE CLINICAL INDICATOR

CI 2.1 Unplanned return to hospital – adult/paediatric patient This CI remains the most popular indicator collected and submitted and, it is thus reasonable to suggest, the most useful. Nineteen HCOs contributed data on almost 70,000 HITH episodes. It would appear that not only are more HCOs submitting data, but HITH is growing. The overall rate of unplanned return of a HITH patient to hospital remains less than 1%. This suggests that hospitals are choosing their patients carefully and delivering care in a way that ensures completion of the HITH episode. This reassures patients and referring clinicians that HITH is capable of doing what is says it can do.

HOSPITAL IN THE HOME HOSPITAL IN THE HOME

SUMMARY OF RESULTS

In 2018 there were 135 submissions from 20 HCOs for 9 CIs. None were analysed for trend. In 2018, significant stratum variation was observed in 2 CIs. Five CIs showed greater systematic variation, with centile gains in excess of 50% of all events. Outlier gains in excess of 25% of all events were observed in 3 CIs. See Summary of Indicator Results below.

Summary of Indicator Results

Indicator HCOs Aggregate rate %

Best Stratum Outlier HCOS (%)* Outlier Gains (%)+ Centile Gains (%)+ Events# Trend

Patient safety, selection, communication and care co-ordination 1.1 Unexpected clinical telephone calls - adult/paediatric patient (N) 10 0.723 1.3 Unexpected administrative telephone calls - adult/paediatric patient (L) 7 0.143 2 (29%) 13 (50%) 20 (77%) 26

1.5 Unscheduled clinical assessment - adult/paediatric patient (L) 13 0.438 Vic 4 (31%) 38 (27%) 100 (70%) 143

Service interruption 2.1 Unplanned return to hospital - adult/paediatric patient (L) 2.2 Unplanned return to hospital - neonatal patient (L) 19 0.778

2 0.739 6 (32%) 112 (21%) 298 (55%) 544

1 (50%) 5 (38%) 9 (69%) 13

2.3 Unplanned return to hospital within 24 hours - adult/paediatric patient (L) 16 0.152 Vic 2 (13%) 6 (6%) 70 (74%) 94

2.4 Unplanned return to hospital within 24 hours - neonatal patient (L) 2 0 -

Unexpected deaths 3.1 Unexpected deaths during HITH admission - adult/paediatric patient (L) 10 0.0058 2

3.2 Unexpected deaths during HITH admission - neonatal patient (L) 1 0 -

# Number of undesirable or non-compliant events + % of events that contribute to outlier/centile gains * % of outlier HCOs