Examining the hospital and aged care interface
How were hospitalisations defined?
In this report, hospitalisations include those where the patient was discharged one or more days after being admitted to hospital (excluding any time spent in emergency departments).
A hospitalisation starts when a person is admitted to hospital and ends when they are discharged from hospital or die in hospital. Adjoining admitted patient episodes of care were combined into a single hospitalisation, ensuring that the entire hospitalisation includes first admission to discharge from the hospital system (or death in hospital).
Episodes of care refer to periods of admitted patient care with one care type, in one ward and in one hospital. If a person receives a new type of care, moves to a different ward in the same hospital or is transferred to another hospital, the episode of care ends and a new episode of care begins. People who receive one care type and do not move between wards or hospitals have one episode of care that encompasses their entire hospitalisation.
Linked data are required to combine distinct episodes of care into hospitalisations. Further information on how hospitalisations were identified using the linked data is in Technical notes.
First hospitalisation
The study focused on transitions of care before and after, and health outcomes after, each person’s first hospitalisation ending in 2017. This includes hospital admissions that commenced in 2017 (or earlier) that resulted in discharge or death in 2017. For people who had more than one hospitalisation ending in 2017, the first hospitalisation is the one that occurred earliest in the year.
Usual residence and residential aged care service use
How was usual residence defined?
In this report people were categorised as living in residential aged care if they either lived in a residential aged care facility as a permanent resident or accessed respite care in a residential aged care facility. A very small proportion of people living with dementia (1%) and people without dementia (0.1%) accessed respite care before their hospitalisation and these people typically transitioned to living in residential aged care as a permanent resident without returning to live in the community.
Everyone not categorised as living in residential aged care was categorised as living in the community.
When were transitions in usual residence examined?
People’s usual residence was examined at four key periods before or after their first hospitalisation:
- on the day of admission
- within 7-days of discharge
- within 3-months of discharge
- within 12-months of discharge.
Changes in each person’s usual residence was examined between admission to hospital and 7-days, 3-months and 12-months after discharge from hospital.
Transitions in care 7-days after discharge for community-dwellers
Within 7-days of discharge from hospital, people who lived in the community on the day they were admitted to hospital were categorised into one of the following transition groups:
- Community-dwellers – people who did not live in residential aged care at any time during this period.
- Transitioned to residential aged care – people who transitioned to living in residential aged care during this period after hospitalisation.
- Died (community-dwellers) – people who died during their first hospitalisation or at any time during this period.
Transitions in care 7-days after discharge for aged care residents
Within 7-days of discharge from hospital, people who lived in residential aged care on the day they were admitted to hospital were categorised into one of the following transition groups:
- Aged care residents – people who lived in residential aged care at any time during this period after discharge from hospital.
- Died (aged care residents) – people who died during their first hospitalisation or at any time during this period.
A very small number of people moved from residential aged care to live in the community within 7-days after their first hospitalisation. Due to small counts, this group was excluded from all analyses. Note also that it was not possible to examine use of community aged care or transition care programs using the NIHSI 2018–19 data.
12-month outcomes following first hospitalisation
Place of death was reported for people who died in the 12-months after their first hospitalisation. This includes whether the person died while living in the community, in residential aged care, in hospital or in the emergency department.
Use of key hospital and Medicare-subsidised healthcare services in the 12-months after their first hospitalisation were examined for people who survived 12-months from their first hospitalisation. These included:
- Subsequent hospitalisations
- Emergency department presentations
- GP consultations
- Specialist consultations
- Allied health services
- Medication management reviews
- Chronic disease management services
- Geriatrician referred management plans.
Further information on key variables used from each data source is provided in Technical notes.