Ageing population
In Hong Kong
• 1 out of 4 reach 65 years
of age by 2041
• 68% of all unplanned
Emergency readmission
• 50% of all patient bed
days
In United Kingdom
• Age over 65 will be double
up by 2050
• 2 millions unplanned
admission
• 68% of hospital emergency
bed days
Acute beds ↓↓↓ 1/3 in 25
years Acute beds are increasing
Factors of hospital admission
Availability of
community services
How hospital
services are
managed
Patient attributes
Access to hospital
services
Success indicators in hospital
avoidance
1. Rate of attendance & readmission rate in AED
2. How many of these are avoidable ?
3. Any admission diversion scheme ?
4. Any prediction tools ?
5. Any admission avoidance scheme ?
Useful data about UK & HK in health service
Health Service (2010/11)
UK HK
Public/ Private health
expenditure
84/16% 49/51%
Attributes Fully responsible Nearly fully
subsidized (public)
In/ Out Patient (Public Health Expenditure)
59/41%
55/45%
E attendance rate (Per 1000 population)
312 (London) 314
Avoidable admission 6-20% 41%
LOS (days) 6/ 5.3 (England) 5.6
Readmission rate (28 days)
7% 10.4%
Elements to the success
1. Risk prediction tools
2. Telehealth
3. Case empowerment
4. Case management
5. Hospital alternatives/ mode of admission
6. Early review by senior clinician in AED
UK and HK Practices in Hospital Avoidance
UK HK
AED
Screening by
• Geriatrician • Liaison nurse
Co-joint screening with medical
colleagues in winter surge only
(Individual cluster)
After admission ACE team for early integrated
discharge
Pre-discharge team for early
supported discharge, EDD/ ESD
program
Intermediate care Extended care at care home Rehabilitation & convalescence
hospital
Home
Community supports:
1. 111 hotline 2. Community Matron/ District
nurse
3. Public education
4. Tied GP
5. Case empowerment
6.
a) Virtual ward
b) Community ward
& Acute home visiting
services
c) telephone messaging
services (District nurse)
Community supports:
1. Community health call 2. GOPC/SOPD
3. GPs: GOPC PPP (HA), Elderly
health care voucher (DH)
4. Outreach team: CGAT, CNS &
Palliative care team
5. Public education (DH)
6. Functional support: Cataract/
Joint replacement/ Dental care/
expand drug formulary
7.
8. Transitional respite residential
services
9. Case empowerment : 8765 hours
self empowerment
Case management
Case management
Case Management &/ Telehealth
Promising of
a. Enhance quality of life
b. Reduce avoidable hospital admission &
readmission
c. Shortening length of stay
1. An evaluation of the impacts of “Virtual Wards” on frail patients receiving community nursing services at home : A case-based mixed-method approach (2013)
2. An evaluation of the case management service provided by the community outreach team (2014)
3. Teleconsultation – Airedale NHS Foundation Trust (2011)
Target groups: Individuals &
residents in Nursing Home
Useful data about UK & HK in health service
Health Service (2013) UK HK
GDP 9.4% 5.1% Hospital beds *
(Public & Private)
2.9 4
Nurses & midwives * 7.2 7
Physicians *
2.8
1.8
Public Private
0.76 1.04
Coverage of in-patients
88% 12%
* per 1000 populations
1. Health Facts of Hong Kong 2014 edition
2. 2.15 World Development Indicators: Health systems
3. Food and Health Bureau: Health Care Resources- Hospital beds (Under the definition of OECD Health Data)
4. Public/ private share by in-patient bed day occupied in 2011
Comparisons in Case Management
& Telehealth (HK)
Not on 24 hours support
Partial & limited coverage
Minimal participation of physicians
Mostly Nurse-led
Barriers to the success
1. Cost effectiveness & efficiency ?
2. Shortage of medical staffs in public sector
3. Resources allocation
Recommendations
1. Explore existing programs on case management &
telehealth in terms of cost effectiveness & efficiency
2. Cope with shortage of medical staffs
a) Co-joint with GPs
b) Develop protocols driven pathways
c) Nurse led approach
d) Use of advanced technologies
3. Support of intravenous therapy at home/ nursing
home
Recommendations
4. Expand telehealth service to 24 hours by
experienced nurses on shared electronic health
records
5. Enhance End of Life Care
- Encourage early advanced directives
- 24 hours support
- Under Gold Standards Framework (GSF)
- Encourage die in peace & familiar place
At a glance
2. Case management can effectively reduce hospital
avoidable admission & readmission
1. Hospital admission is not the default option
but last resort to the elderly
4. Use of existing health services & co-joint with GPs
supporting treatments at out-of-hospital places will
be the long run for success
3. 24 hours telehealth can minimize hospital admission
especially out of hours
5. Specialties as advisors to community health
services will fill up the gaps in quality support
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