The Pathways in Aged Care (PIAC) project is a cohort study designed to explore care transitions and care pathways for older Australians. For this project, a national database has been created that links data on assessments undertaken through the Aged Care Assessment Program (ACAP) to death records on the National Death Index, and to data on service use patterns (with dates of use) for five key aged care programs including Home and Community Care (HACC).

The issues

After linking HACC clients to the PIAC cohort, we needed to incorporate HACC use into the event pathway, that is, into the timeline of events that constitutes the care pathway. Three main issues arise due to complications with the HACC data:

  • The HACC National Minimum Data Set (NMDS) data in the project only indicate quarterly use and not specific dates. How do we present HACC use in the PIAC pathways to allow for this? In particular, how can we tell if HACC services were accessed before or after the first ACAP assessment when they occurred in the same quarter?
  • Just over 80% of HACC agencies participate in the NMDS. How do we deal with this problem of incomplete coverage?
  • Some HACC services can be accessed by people on community care packages and some cannot, depending on the package type. How do we allow for this?

The analysis

Various approaches are examined for the representation of HACC service events in care pathways and, in particular, to derive and adjust HACC dates to allow for other pathway events. The report presents the analyses that led to the adoption of the final approach (see Section 8 for a summary of the final algorithm). The derived method could be applied more generally in analysing the use of HACC services over time. In addition, the analyses presented provide useful background for any further development of the HACC NMDS.