Background
The Hospital Dementia Services Project (HDS Project) is a three-year NHMRC-funded project which is looking at outcomes for people with dementia admitted to hospital.
In Australia the mean length of stay (LOS) for all hospital separations for people who stay at least one night is 8.6 days, compared with a mean of 19.6 days for separations with any diagnosis of dementia and 30.1 days for separations with a principal diagnosis of dementia (AIHW 2007). The relatively higher casemix complexity of patients with dementia contributes to longer hospital stay and this has an impact on patients' physical and mental state (King et al. 2006; Nichol, Lonergan and Mould 2000; ACEMA 2003, p.14). There is evidence that well targeted and designed services improve the quality of care for people with dementia (Hales et al. 2006; Foreman & Gardner 2005; Corbett et al. 2005; Nay et al. 2000).
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Objectives
The overarching objective of the project is to inform health practitioners, health and aged care policy makers and planners, and consumers about the influence of system-level factors on care outcomes for hospital patients with dementia. Outcomes of interest include hospital admission rates, length of stay in hospital, care outcomes such as falls and complications, discharge rates to residential aged care, dependency levels on entry to residential aged care.
Project streams
See also Figure 1: Outcomes for people with dementia admitted to hospital: NHMRC Dementia Research Grant-Project streams (327KB PDF)
Stream 1 will describe hospital stay and patient accommodation outcomes for patients with dementia, and compare them with those of other older public hospital patients. This will be based on analysis of linked data from existing administrative datasets (NSW hospital, residential aged care and Aged Care Assessment Program data) focusing on older patients (50+ years) discharged from NSW public hospitals in 2006-07. Data linkage is being undertaken in accordance with procedures approved by relevant Ethics Committees and will follow the protocol developed and used extensively at AIHW.
Stream 2 will describe aged care and dementia-specific services in NSW in 2006-07 through a survey of all public hospitals and follow-up site visits in selected locations. Findings from the survey and interviews will be used to develop a typology of hospital-based aged care and dementia services. This stream will also involve the collection of information to describe the aged care programs operating at the regional level.
In Stream 3, the material collected in Streams 1 and 2 will be brought together to explore outcomes for people with dementia who are admitted to hospital and the factors which influence these. The study will not directly compare specific hospitals or Area Health Services but will explore the influence of different kinds of hospital and aged care service and delivery patterns on a range of outcomes for people with dementia.
Dissemination and engagement activities (Stream 4) will be conducted throughout the project and are a central component of the study. In particular, hospital site visits and Area Health Service workshops are intended to allow an iterative dialogue with local experts to ensure that the study provides findings that can be used to inform practice.
References
- ACEMA (Aged Care Evaluation and Management Advisors) (2003). Examination of Length of Stay for Older Persons in Acute and Sub-Acute sector. Report for the AHMAC Working Group on the Care of Older Australians, February 2003.
- AIHW (Australian Institute of Health & Welfare) (2007). Dementia in Australia: National data analysis and development. AIHW cat. no. AGE 53. Canberra: Australian Institute of Health and Welfare.
- Corbett, H., Lim, W., Davis, S. & Elkins, A. (2005). Care coordination in the Emergency Department: improving outcomes for older patients. Australian Health Review, 29 (1), 43-50.
- Foreman, P. & Gardner, I. (2005). Evaluation of Education and Training of Staff in Dementia Care and Management in Acute setting. Report for the Department of Human Services, April 2005.
- Hales, C., Ross, L. & Ryan, C. (2006). National evaluation of the Aged Care Innovative Pool Dementia Pilot: final report. AIHW cat. no. AGE 48. Canberrra: Australian Institute of Health and Welfare.
- King, B., Jones, C., & Brand, C. (2006). Relationship between dementia and length of stay of general medical patients admitted to acute care. Australasian Journal on Ageing 25(1):20-23.
- Nay, R. et al. (2000). Improving the admission and discharge practices of acute and subacute facilities in relation to people with dementia. Report to Victorian Department of Human Services.
- Nichol, B., Lonergan, J. & Mould, M. (2000). The use of hospitals by older people: a casemix analysis. Occasional Papers: New Series no. 11. Canberra: Commonwealth Department of Health and Aged Care.
