Reduction ofReduction of HospitalizationHospitalization CostCostafter after ImplementationImplementation of of CVMOCVMOProgram Program In In Hong KongHong Kong West West

Cluster Cluster ––The First Year ResultThe First Year Result

HA Convention 2007

Hong Kong West Community Geriatric Assessment Team, Fung Yiu King Hospital

Community Nursing Department, Queen Mary Hospital

• In HKWC, the Phase III CGAS/CVMO Collaboration Scheme has been started since May 2005

AIMs of the CVMO program

• To reduce A&E attendance and unplanned hospital admission POAHs (private old age homes)

• To provide quality medical care and enhance infection control in POAHs

• Cost reduction?

Members

• Geriatricians of HKWC• Community Visiting Medical Officer

(CVMO)• Community Geriatric Assessment

Team (CGAT) of FYK Hospital• Community Nurses (CN) of HKWC

• 8 POAHs with total capacity of 1,087 in HKWC were recruited in the project

• A full time CVMO with CGAT experience is responsible to conduct regular doctor’s clinic in POAHs 2 to 3 times per week

Targeted Patients

• High risk elderly whom recently attended A&E department or recently discharged from hospital

• Elderly with unstable medical condition

• Elderly with ad hoc medical problems

Role of the CVMO in POAHs

• Clinical assessment of patient’s condition after discharged from hospital or A&E

• Readjust and fine-tuning of treatment and medications

• Timely intervention of ad hoc medical problems

• Patient and staff education • Infection control

CVMO program reported in HA Convention 2006

• Preliminary six-month results (May to October 2005 compared with the same period 2004)

• There was:•11.6% reduction in A&E

attendance •18.3% reduction in

unplanned admission

Objectives of the present study

• To further examine the effect of one-year CVMO program on POAHsresidents in terms of– A&E attendance– Unplanned hospital admission– Length of hospital stay (LOS)– Cost of hospitalization

Study Period

• Retrospective approach• Study period: May 2005 to April

2006• Control period: May 2004 to April

2005

Control

5/04 5/05 4/06

CVMO started

Data Collection• Data collection:

– number of A&E attendance– number of hospital admissions (acute and

convalescence)– length of hospital stay

• Clinical admissions to medical subspecialitywards (e.g. renal ward for dialysis) or non-medical wards were excluded

• The difference in cost of hospital stay was calculated

Results• Total number of residents at the

beginning of the study: 615– 87 died– 19 moved out

• 509 residents included• Mean age: 82.4 (52 to 101)

– Male: 171 (33.6%)– Female: 338 (66.4%)

Sample CharacteristicsMobility % (N)

Ambulatory 49.3 (251)

Chairbound 44 (224)

Bedbound 6.8 (34)

BADL FunctionIndependent 38.7 (197)

Assisted 30.4 (155)

Dependent 30.8 (157)

FeedingOral 88.8 (452)

Ryles Tube 10.8 (55)

PEG 0.4 (2)

ContinenceContinent 44.4 (226)

Incontinent 55.6 (283)

CVS % (N) Gastrointestinal & Hepatobiliary % (N)

Heart Disease 27.7 (141) Liver Cirrhosis 1 (5)HT 60.5 (308) GIB 10.4 (53)Respiratory Endocrine

Asthma / COAD 6.9 (35) Diabetes Mellitus 25 (126)

7.8 (40)

Tuberculosis 6.7 (34) Thyroid Disorder 2.3 (12)Neurological and Psychiatric MiscellaneousCVA 38.9 (198) MalignancyDementia 27.7 (141) Anaemia 7.7 (39)Depression 5.5 (28) Cataract 14.5 (74)Epilepsy 3.5 (18) Fracture 19.6 (100)Parkinsonism 7.3 (37) Gout 10 (51)Psychosis 2.4 (12) LBP 6.6 (34)Renal Osteoarthritis 7.5 (38)Chronic Renal Failure 3.7 (19) Rheumatoid Arthritis 0.6 (3)

Chronic Disease Profile

A&E Attendance And Hospital Admissions

21

169

19

336

142

422

0

50

100

150

200

250

300

350

400

450

Clinical Hospital Admission Unplanned HospitalAdmission

A&E Attendance WithoutAdmission

Before After

One year after CVMO program

• A reduction of 27 (169 to 142) A&E attendance – =reduction from 0.33 to 0.28

attendance/person/year– =15.2% reduction

• A reduction of 86 (422 to 336) unplanned hospital admission– = reduction from 0.83 to 0.66

admission/person/year – =20.5% reduction

Case scenario 1• Ms Leung, age:86• DM, HT, history of AMI in 2003 &

2004

Admission Records

Date DiagnosisRH

RH

RH

QMH

RH

RH

RH

22/2/05 – 26/2/05 CHF

17/7/05 – 22/7/05 poor DM control

28/7/05 – 9/8/05 CHF

29/8/05 – 31/8/05 poor DM control

2/9/05 – 10/9/05 UTI, poor DM control

16/9/05 – 27/9/05 CHF

29/9/05 – 6/10/05 CHF

What we did…

• a case conference was conducted including geriatrician, CVMO, CGAT Geriatric nurses, Community nurses and OAH staff about patient’s condition and formulation of management plan

• patient was follow up weekly by CVMO to review DM control and hydration status, and drug titration if necessary

Outcome is…

• DM control greatly improved and patient did not have heart failure symptoms after treatment

• no further A&E attendance or hospitalization

Case Scenario 2• M/63• PH: cervical myelopathy on long term urinary

catheter• Repeated A&E attendance and hospitalization

because of urinary tract infection and foleyblockage

• Collaborate with Community nurses and POAH staff for close monitoring:– urinary symptoms– urine flow from catheter– adjust the schedule of change foley catheter– antibiotics treatment in POAH

• The A&E attendance and hospitalization reduced afterwards

Hospital Bed Days

2278

2571

1938

2822

0

500

1000

1500

2000

2500

3000

Convalescence Hosp. Acute Hosp.

Before After

•Reduction of hospital bed days in:

– Acute hospital: 340 days– Convalescence hospital: 251 days

Cost Reduction

• In HKWC, the cost of acute medical bed day is HK$ 2810

• In HKWC, the cost of convalescence hospital bed day is HK$1,400

• **HAHO Finance Department: Financial Reports and Information : 2005/06 costing information package

Total cost saved

• The cost saved after CVMO program is – $ 340 x 2810 = 955,400 in acute hospital – $ 251 x 1400 = 351,400 in convalescence

hospital

• Total cost saved: 955,400 + 351,400 = $1,306,800

Conclusion• The CVMO program is effective in

reducing:– A&E attendance– Unplanned hospital admission– Hospital bed days and cost of

hospitalization in acute and convalescence hospitals

THANK YOU