Occupied Bed-Days for People Aged 75+ Admitted as an Emergency 2 Times or More per Year
- 1 Basic Facts
- 2 Potential or current usage=
- 3 Brief overview of the measure
- 4 Application and interpretation of the measure
- 5 Calculation of the measure
- 6 Appraisal of the measure
- 7 Other items
- 8 Owner details
Stage of development
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
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
Domain(s) of quality
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.
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.
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.
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.
People aged under 75. Elective admissions. Mental health admissions.
DHB population aged 75+
Mental health admissions.
12 months (one financial year)
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).
Date of entry to library
Owner (Organisation name)
Health Quality & Safety Commission, Indicator Project Team
Owner (Email contact)
Creator (Organisation name)
Health Quality & Safety Commission, Indicator Project Team