Jump to: navigation, search

Occupied Bed-Days for People Aged 75+ Admitted as an Emergency 2 Times or More per Year

Basic Facts

Stage of development

Implemented

Potential or current usage=

This measure is used as a measure for the effectiveness of integration of primary, acute, and long stay care.

Brief overview of the measure

General description

Occupied bed days for people aged 75+ is a process and outcome measure of the effectiveness of health services in providing alternative care at home where possible and appropriate.

Rationale for selection

This measure is shown in both England and Scotland to be a useful proxy for the effectiveness of integration of primary, acute and long stay care, showing both effectiveness of avoiding unnecessary admissions, and ability to “step down” to less intensive forms of care. This measure offers the potential to identify ppportunities for reductions in number of admissions and/ or length of stay through the provision of effective alternative care at home or in residential care settings. Evidence from England suggests that achievable elimination of variation would have released crica $4bn (equivalent to 2.5% of the NHS budget) back into the NHS.

Type of measure

Outcomes

Domain(s) of quality

Effectiveness

Application and interpretation of the measure

Stated intent of the measure

To measure the length of stay for patients who have had two or more emergency admissions to identify opportunities for reductions through effective alternative care at home, in a cost-effective system-wide care of older people that will raise the quality and lower the cost of late-life care, maximising opportunities for even the frailest older people to remain at home for as long as possible.

Caveats - Considerations

Some variation seen in the results of this measure will be related to demographic factors. The numerator definition represents a slight understatement of the actual position as patients who admit more than twice within a rolling year, but where those admissions are either side of the calendar year end, will not be included. It is important to note that this measure is affected by organisation of all aspects of health and aged care; a high number of occupied bed days cannot be attributed to the actions of the hospitals alone but also of access to and quality of primary, in-home and residential care, and the degree of successful integration between all four. Level of health care delivery/setting This measure reflects the effectiveness of the health system to shift the balance of care away from the hospital and care home towards the home for as long as possible. It covers the interface between community and hospital care.

Target population

This indicator is targeted at the 75+ age range. It is inclusive of all ethnicities and genders.

Stratification by vulnerable populations

If proxy is available (i.e. query by quintile), then stratification by ethnicity and socio economic status may be of interest.

Associated incentives

If applicable, identify linkage to existing programmes with incentive frameworks

Possible sources of bias or confounding

Includes practitioner, organisational and patient factors e.g. demography, case mix, compliance that need to be allowed for when interpreting results.

Calculation of the measure

Output of calculation

Total occupied bed days for patients 75 and over who had two or more emergency admissions within a calendar year.

Numerator description

Occupied bed days (discharge date - admission date) for all patients aged 75 and over who had two or more emergency admissions within a calendar year, by DHB of residence.

Numerator exclusions

People aged under 75. Elective admissions. Mental health admissions.

Denominator description

DHB population aged 75+

Denominator exclusions

Mental health admissions.

Time period

12 months (one financial year)

Data source

Nominator: NDMS Denominator: StatsNZ/MoH

Method of extraction

Use the patient NHI to identify people with more than two emergency admissions to hospital. Count the bed days for the relevant patients. Divide by the total DHB population aged 75+.

Key issues and challenges for data management

The numerator definition represents a slight understatement of the actual position as patients who admit more than twice within a rolling year, but where those admissions are either side of the calendar year end will not be included. This approach requires a unique identifier in order to establish the population to whom the occupied bed days applies.

Appraisal of the measure

Availability of evidence to support application of the measure

Measure is formulated on and underpinned by an evidence based clinical practice guideline., A formal consensus procedure involving experts in relevant clinical and/or methodological sciences has been completed and documented., The measure has been developed or endorsed by an organization that promotes rigorous development and use of clinical performance measures (at an international, national, regional or local level)., The measure has been developed or endorsed by an organisation seeking to improve clinical effectiveness as part of a continuous quality improvement cycle (at an international, national, regional or local level).

Evidence of feasibility and reliability of implementation

Reliability - The measure has been demonstrated to be reliable (i.e. free from random error)., Interpretation - The measure allows unambiguous interpretation of better or worse performance., Data extraction - Data collection specifications for the measure are well defined., Data sources - Required data elements for the measure can be obtained from existing data sources., Availability of data - Required data elements for the measure can be gathered during routine practice activities, IT software - Existing IT software is sufficient for data collection., Validity - The measure has been demonstrated to be valid (i.e. it measures what it purports to).

Other items

Owner details

Reference number

866

Date of entry to library

2012-05-31 14:10:14

Owner (Organisation name)

Health Quality & Safety Commission, Indicator Project Team

Owner (Email contact)

richard.hamblin@hqsc.govt.nz

Creator (Organisation name)

Health Quality & Safety Commission, Indicator Project Team

Creator (Email contact)