The effectiveness and cost effectiveness of a hospital avoidance program in a residential aged care facility: a prospective cohort study and modelled decision analysis

Article

Carter, Hannah E., Lee, Xing J., Dwyer, Trudy, O'Neill, Barbara, Jeffrey, Dee, Doran, Christopher M., Parkinson, Lynne, Osborne, Sonya R., Reid-Searl, Kerry and Graves, Nicholas. 2020. "The effectiveness and cost effectiveness of a hospital avoidance program in a residential aged care facility: a prospective cohort study and modelled decision analysis." BMC Geriatrics. 20, pp. 1-9. https://doi.org/10.1186/s12877-020-01904-1
Article Title

The effectiveness and cost effectiveness of a hospital avoidance program in a residential aged care facility: a prospective cohort study and modelled decision analysis

ERA Journal ID15806
Article CategoryArticle
AuthorsCarter, Hannah E. (Author), Lee, Xing J. (Author), Dwyer, Trudy (Author), O'Neill, Barbara (Author), Jeffrey, Dee (Author), Doran, Christopher M. (Author), Parkinson, Lynne (Author), Osborne, Sonya R. (Author), Reid-Searl, Kerry (Author) and Graves, Nicholas (Author)
Journal TitleBMC Geriatrics
Journal Citation20, pp. 1-9
Article Number527
Number of Pages9
Year2020
PublisherBioMed Central Ltd.
Place of PublicationUnited Kingdom
ISSN1471-2318
Digital Object Identifier (DOI)https://doi.org/10.1186/s12877-020-01904-1
Web Address (URL)https://bmcgeriatr.biomedcentral.com/articles/10.1186/s12877-020-01904-1
Abstract

Background
Residential aged care facility residents experience high rates of hospital admissions which are stressful, costly and often preventable. The EDDIE program is a hospital avoidance initiative designed to enable nursing and care staff to detect, refer and quickly respond to early signals of a deteriorating resident. The program was implemented in a 96-bed residential aged care facility in regional Australia.

Methods
A prospective pre-post cohort study design was used to collect data on costs of program delivery, hospital admission rates and length of stay for the 12months prior to, and following, the intervention. A Markov decision model was developed to synthesize study data with published literature in order to estimate the costeffectiveness of the program. Quality adjusted life years (QALYs) were adopted as the measure of effectiveness.

Results
The EDDIE program was associated with a 19% reduction in annual hospital admissions and a 31% reduction in the average length of stay. The cost-effectiveness analysis found the program to be both more effective and less costly than usual care, with 0.06 QALYs gained and $249,000 health system costs saved in a modelled cohort of 96 residents. A probabilistic sensitivity analysis estimated that there was an 86% probability that the program was cost-effective after taking the uncertainty of the model inputs into account.

Conclusions
This study provides promising evidence for the effectiveness and cost-effectiveness of a nurse led, early intervention program in preventing unnecessary hospital admissions within a residential aged care facility. Further research in multi-site randomised studies is needed to confirm the generalisability of these results.

Keywordshospital avoidance; residential aged care; regional Australia
ANZSRC Field of Research 2020420502. Aged care nursing
Byline AffiliationsQueensland University of Technology
Central Queensland University
PresCare, Australia
School of Nursing and Midwifery
Duke-NUS Medical School, Singapore
Open access urlhttps://bmcgeriatr.biomedcentral.com/articles/10.1186/s12877-020-01904-1
Institution of OriginUniversity of Southern Queensland
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Webster, Joan, Osborne, Sonya, Rickard, Claire M and Marsh, Nicole. 2019. "Clinically-indicated replacement versus routine replacement of peripheral venous catheters." Cochrane Database of Systematic Reviews. 2019 (1), pp. i-55. https://doi.org/10.1002/14651858.CD007798.pub5
Evaluation of the efficacy of 3D total-body photography with sequential digital dermoscopy in a high-risk melanoma cohort: Protocol for a randomised controlled trial
Primiero, Claire Amy, McInerney-Leo, Aideen M., Betz-Stablein, Brigid, Whiteman, David C., Gordon, Louisa, Caffery, Liam, Aitken, Joanne F., Eakin, Elizabeth, Osborne, Sonya, Gray, Len, Smithers, B. Mark, Janda, Monika, Soyer, H. Peter, Finnane, Anna, Primiero C.A., McInerney-Leo A.M., Betz-Stablein B., Whiteman D.C., Gordon L., ..., Finnane A.. 2019. "Evaluation of the efficacy of 3D total-body photography with sequential digital dermoscopy in a high-risk melanoma cohort: Protocol for a randomised controlled trial." BMJ Open. 9 (11). https://doi.org/10.1136/bmjopen-2019-032969
Retained Surgical Items: Lessons from Australian Case Law of Items Unintentionally Left Behind in Patients after Surgery
Cockburn, Tina, Davis, Juliet and Osborne, Sonya. 2019. "Retained Surgical Items: Lessons from Australian Case Law of Items Unintentionally Left Behind in Patients after Surgery." Journal of Law and Medicine. 26 (4), pp. 841-848.
Implementation of simulation modelling to improve service planning in specialist orthopaedic and neurosurgical outpatient services
Moretto, Nicole, Comans, Tracy A., Chang, Angela T., O'Leary, Shaun P., Osborne, Sonya, Carter, Hannah E., Smith, David, Cavanagh, Tania, Blond, Dean and Raymer, Maree. 2019. "Implementation of simulation modelling to improve service planning in specialist orthopaedic and neurosurgical outpatient services." Implementation Science. 14 (1), pp. 1-11. https://doi.org/10.1186/s13012-019-0923-1
Reviewing ACORN nursing role ‘anaesthetic nurse'
Ireland, Sue and Osborne, Sonya. 2016. "Reviewing ACORN nursing role ‘anaesthetic nurse'." Journal of Perioperative Nursing. 29 (4), pp. 54-57.
Surgical hand antisepsis, gowning and gloving — not necessarily the way it has always been done
Johnson, Julie and Osborne, Sonya. 2016. "Surgical hand antisepsis, gowning and gloving — not necessarily the way it has always been done." Journal of Perioperative Nursing. 29 (2), pp. 52-54.
Recent updates to our national standards
Osborne, Sonya. 2016. "Recent updates to our national standards." Journal of Perioperative Nursing. 29 (1), pp. 54-55.
Candida albicans colonisation, continence status and incontinence-associated dermatitis in the acute care setting: a pilot study
Campbell, Jill L., Coyer, Fiona M., Mudge, Alison M., Robertson, Ivan M. and Osborne, Sonya R.. 2016. "Candida albicans colonisation, continence status and incontinence-associated dermatitis in the acute care setting: a pilot study." International Wound Journal. 14 (3), pp. 488-495. https://doi.org/10.1111/iwj.12630
Nursing and medical perceptions of a hospital rapid response system new process but same old game?
Douglas, Clint, Osborne, Sonya, Windsor, Carol, Fox, Robyn, Booker, Catriona, Jones, Lee and Gardner, Glenn. 2016. "Nursing and medical perceptions of a hospital rapid response system new process but same old game?" Journal of Nursing Care Quality. 31 (2), pp. E1-E10. https://doi.org/10.1097/NCQ.0000000000000139
A point about sharps safety
Osborne, Sonya. 2014. "A point about sharps safety." ACORN: the journal of perioperative nursing in Australia. 27 (1), pp. 8-9.
Author response: NPO practices and preoperative oral carbohydrate intake
Webster, Joan and Osborne, Sonya Ranee. 2014. "Author response: NPO practices and preoperative oral carbohydrate intake." AORN Journal. 99 (6), p. 673. https://doi.org/10.1016/j.aorn.2014.03.007
Incontinence-associated dermatitis: a cross-sectional prevalence study in the Australian acute care hospital setting
Campbell, Jill L., Coyer, Fiona M. and Osborne, Sonya R.. 2014. "Incontinence-associated dermatitis: a cross-sectional prevalence study in the Australian acute care hospital setting." International Wound Journal. 13 (3), pp. 403-411. https://doi.org/10.1111/iwj.12322
What factors influence nurses’ assessment practices? Development of the Barriers to Nurses’ use of Physical Assessment Scale
Douglas, Clint, Osborne, Sonya, Reid, Carol, Batch, Mary, Hollingdrake, Olivia and Gardner, Glenn. 2014. "What factors influence nurses’ assessment practices? Development of the Barriers to Nurses’ use of Physical Assessment Scale." Journal of Advanced Nursing. 70 (11), pp. 2683-2694. https://doi.org/10.1111/jan.12408
An integrated educational model for continuing nurse education
Duff, Beverley, Gardner, Glenn and Osborne, Sonya. 2014. "An integrated educational model for continuing nurse education." Nurse Education Today. 34 (1), pp. 104-111. https://doi.org/10.1016/j.nedt.2012.11.022
The primacy of vital signs – Acute care nurses’ and midwives’ use of physical assessment skills: a cross sectional study
Osborne, Sonya, Douglas, Clint, Reid, Carol, Jones, Lee and Gardner, Glenn. 2015. "The primacy of vital signs – Acute care nurses’ and midwives’ use of physical assessment skills: a cross sectional study." International Journal of Nursing Studies. 52 (5), pp. 951-962. https://doi.org/10.1016/j.ijnurstu.2015.01.014
Preoperative bathing or showering with skin antiseptics to prevent surgical site infection (Review)
Webster, Joan and Osborne, Sonya. 2015. "Preoperative bathing or showering with skin antiseptics to prevent surgical site infection (Review)." Cochrane Database of Systematic Reviews. https://doi.org/10.1002/14651858.CD004985.pub5
Perioperative nursing
Sutherland-Fraser, Sally, Osborne, Sonya and Bryant, Kim. 2016. "Perioperative nursing." Hamlin, Lois, Davies, Menna, Richardson-Tench, Marilyn and Sutherland-Fraser, Sally (ed.) Perioperative nursing: an introduction. Marrickville, Australia. Elsevier. pp. 1-29
Author response: missed opportunity related to statistical methods
Osborne, Sonya Ranee, Jones, Lee and Webster, Joan. 2014. "Author response: missed opportunity related to statistical methods." AORN Journal. 99 (6), pp. 675-677. https://doi.org/10.1016/j.aorn.2014.04.002
Incidence and predictors of lower limb split-skin graft failure and primary closure dehiscence in day-case surgical patients
Stankiewicz, Monica, Coyer, Fiona, Webster, Joan and Osborne, Sonya. 2015. "Incidence and predictors of lower limb split-skin graft failure and primary closure dehiscence in day-case surgical patients." Dermatologic Surgery. 41 (7), pp. 775-783. https://doi.org/10.1097/DSS.0000000000000391
The skin safety model: reconceptualizing skin vulnerability in older patients
Campbell, Jill L, Coyer, Fiona M. and Osborne, Sonya R.. 2016. "The skin safety model: reconceptualizing skin vulnerability in older patients." Journal of Nursing Scholarship. 48 (1), pp. 14-22. https://doi.org/10.1111/jnu.12176
Skin preparation of the patient – more than skin deep
Levada, Lilliana and Osborne, Sonya. 2017. "Skin preparation of the patient – more than skin deep." Journal of Perioperative Nursing. 30 (2), pp. 57-59.
Making evidence-based perioperative practices stick: an introduction to an implementation science approach
Osborne, Sonya. 2017. "Making evidence-based perioperative practices stick: an introduction to an implementation science approach." Journal of Perioperative Nursing. 30 (4), pp. 53-55.
New ACORN guideline: perioperative nursing management of posthumous organ procurement
Gore, Amanda and Osborne, Sonya. 2017. "New ACORN guideline: perioperative nursing management of posthumous organ procurement." Journal of Perioperative Nursing. 30 (1 - Autumn), pp. 56-59.
Nursing physical assessment for patient safety in general wards: reaching consensus on core skills
Douglas, Clint, Booker, Catriona, Fox, Robyn, Windsor, Carol, Osborne, Sonya and Gardner, Glenn. 2016. "Nursing physical assessment for patient safety in general wards: reaching consensus on core skills." Journal of Clinical Nursing. 25 (13-14), pp. 1890-1900. https://doi.org/10.1111/jocn.13201
Intrathecal morphine–related perioperative hypothermia in women undergoing cesarean delivery: a retrospective case-control study
Munday, Judy, Osborne, Sonya and Yates, Patsy. 2018. "Intrathecal morphine–related perioperative hypothermia in women undergoing cesarean delivery: a retrospective case-control study." Journal of PeriAnesthesia Nursing. 33 (1), pp. 3-12. https://doi.org/10.1016/j.jopan.2016.04.142
Preoperative warming versus no preoperative warming for maintenance of normothermia in women receiving intrathecal morphine for cesarean delivery: a single-blinded, randomized controlled trial
Munday, Judy, Osborne, Sonya, Yates, Patsy, Jones, Lee and Gosden, Edward. 2018. "Preoperative warming versus no preoperative warming for maintenance of normothermia in women receiving intrathecal morphine for cesarean delivery: a single-blinded, randomized controlled trial." Anesthesia and Analgesia. 126 (1), pp. 183-189. https://doi.org/10.1213/ANE.0000000000002026
Nursing service innovation: a case study examining emergency nurse practitioner service sustainability
Fox, Amanda, Gardner, Glenn and Osborne, Sonya. 2018. "Nursing service innovation: a case study examining emergency nurse practitioner service sustainability." Journal of Advanced Nursing. 74 (2), pp. 454-464. https://doi.org/10.1111/jan.13454
Cohort study of a specialist social worker intervention on hospital use for patients at risk of long stay
Osborne, Sonya, Harrison, Gai, O'Malia, Angela, Barnett, Adrian Gerard, Carter, Hannah E. and Graves, Nicholas. 2018. "Cohort study of a specialist social worker intervention on hospital use for patients at risk of long stay." BMJ Open. 8 (12), pp. 1-6. https://doi.org/10.1136/bmjopen-2018-023127
Does preoperative oral carbohydrate reduce hospital stay? A randomized trial
Webster, Joan, Osborne, Sonya Ranee, Gill, Richard, Chow, Carina Faran Kalan, Wallin, Siobhan, Jones, Lee and Tang, Annie. 2014. "Does preoperative oral carbohydrate reduce hospital stay? A randomized trial." AORN Journal. 99 (2), pp. 233-242. https://doi.org/10.1016/j.aorn.2013.12.003
Quantitative data collection and study validity
Osborne, Sonya and Schneider, Zevia. 2013. "Quantitative data collection and study validity." Schneider, Zevia, Whitehead, Dean, LoBiondo-Wood, Geri and Haber, Judith (ed.) Nursing and midwifery research: methods and appraisal for evidence-based practice. Australia. Elsevier - Mosby. pp. 200-217
Infection control
Osborne, Sonya. 2013. "Infection control." Crisp, Jackie, Potter, Patricia Ann, Taylor, Catherine, Rebeiro, Geraldine and Douglas, Clint (ed.) Potter and Perry's fundamentals of nursing. Chatswood, NSW, Australia. Elsevier - Mosby. pp. 703-752
The ACORN standards - our aide-memoire to professional practice
Osborne, Sonya. 2013. "The ACORN standards - our aide-memoire to professional practice." ACORN: the journal of perioperative nursing in Australia. 26 (4), pp. 14-15.
Clinically-indicated replacement versus routine replacement of peripheral venous catheters [Review]
Webster, Joan, Osborne, Sonya, Rickard, Clare M. and New, Karen. 2013. "Clinically-indicated replacement versus routine replacement of peripheral venous catheters [Review]." Cochrane Database of Systematic Reviews. https://doi.org/10.1002/14651858.CD007798.pub3
Comparing the cost of alcohol-related traffic crashes in rural and urban environments
Czech, Suzanne, Shakeshaft, Anthony P., Byrnes, Joshua M. and Doran, Christopher M.. 2010. "Comparing the cost of alcohol-related traffic crashes in rural and urban environments." Accident Analysis and Prevention. 42 (4), pp. 1195-1198. https://doi.org/10.1016/j.aap.2010.01.010
Nursing management: intraoperative care
Shoup, Anita, Reilly, Maureen, Kless, Jack and Osborne, Sonya. 2012. "Nursing management: intraoperative care." Brown, Diane and Edwards, Helen (ed.) Lewis's medical surgical nursing: assessment and management of clinical problems. Australia. Elsevier. pp. 402-420
Interaction Of myxomatosis and Rabbit Haemorrhagic Disease in wild rabbit
Fulford, G. R., Lee, X. J., Berman, D. and Hamilton, G.. 2011. "Interaction Of myxomatosis and Rabbit Haemorrhagic Disease in wild rabbit." 19th International Congress on Modelling and Simulation (MODSIM2011). Perth, Australia 12 - 16 Dec 2011 New Zealand. Modelling and Simulation Society of Australia and New Zealand . https://doi.org/10.36334/modsim.2011.B2.fulford
Exploring the culture of non-reporting in the perioperative environment
Marshall, J. and Osborne, Sonya. 2007. "Exploring the culture of non-reporting in the perioperative environment." ACORN: the journal of perioperative nursing in Australia. 20 (2), pp. 10-21.
Imperatives and strategies for developing an evidence-based practice in perioperative nursing
Osborne, Sonya and Gardner, Glenn. 2004. "Imperatives and strategies for developing an evidence-based practice in perioperative nursing." ACORN: the journal of perioperative nursing in Australia. 17 (1), pp. 18-24.
Occupational exposures: balancing the costs of prevention vs treatment in operating theatres, with particular focus on double gloving practices
Osborne, Sonya. 2001. "Occupational exposures: balancing the costs of prevention vs treatment in operating theatres, with particular focus on double gloving practices." ACORN: the journal of perioperative nursing in Australia. 14 (2), pp. 16-21.
Care and preventative maintenance of surgical instrumentation: the scrub nurse's responsibility
Osborne, Sonya R.. 1999. "Care and preventative maintenance of surgical instrumentation: the scrub nurse's responsibility." ACORN: the journal of perioperative nursing in Australia. 12 (4), pp. 10-13.
Latex allergy: a perioperative environmental hazard
Osborne, Sonya R.. 1998. "Latex allergy: a perioperative environmental hazard." ACORN: the journal of perioperative nursing in Australia. 11 (4), pp. 26-28.