Kwai Tsing District. Data Source: 2006 Population By-census, Census & Statistics Department, HKSAR 2011 Social Welfare Department, HKSAR

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2 Kwai Tsing District Land Area: 22 sq. km Population: 523,300 Elderly Population: 13.9% (HK Overall = 12.4%) Elderly Dependency Ratio: 191 (HK Overall = 168) Residential Care Homes for the Elderly (RCHE): 52 (HK Overall = 800) RCHE Places: 7,246 (HK Overall = 103,581) Data Source: 2006 Population By-census, Census & Statistics Department, HKSAR 2011 Social Welfare Department, HKSAR

3 Objectives 1. Improve sustainable quality of medical & nursing care for RCHE residents 2. Enhance infection control practices & medical surveillance in RCHEs 3. Reduce utilization of medical in-patient service by RCHE residents

4 Key Actions 1. Designated One-RCHE-one-doctor & One-RCHE-one-nurse to coordinate care & discharge plans 2. Agreed guidelines & care protocols for RCHEs 3. Performed substitutive hospital-athome interventions e.g. parental antibiotics & hydration 4. Hotline & ad-hoc clinic to enable prompt patient management

5 Key Actions 5. Regular training to engage and empower RCHE staffs 6. Sharing Forum (HA, SWD & DH, RCHE) half-yearly to share good practices 7. Joint visit to RCHE (HA, SWD & DH) to strengthen coordinated care 8. Clinical service audit meeting quarterly for CQI

6 RCHE Program 7-Year development 2004 (Phase I) 2005 (Phase II) 2010 (Phase III) 2011 (Phase IV) Covered 5 (10%) RCHEs 1,008 (23%) residents Covered 13 (26%) RCHEs 1,759 (37%) residents Covered 25 (50%) RCHEs 2,723 (62%) residents Covered 31 (62%) RCHEs 3,228 (74%) residents

7 % of AED Attendance / Emergency Admission Bed-days per resident per month Average Hospital Utilization Per RCHE 2004 to % 18.0% 16.0% 14.0% 12.0% 10.0% 8.0% 6.0% 4.0% 2.0% 0.0% AED Attendance Emergency Admission Bed-days per resident per month

8 AED Attendance / Emergency Admissions (Episodes) In-patient length of stay (Bed-Days) Annual Reduction of Hospital Utilization All RCHEs in Project AED Attendance Emergency Admissions (Episodes) In-patient length of stay (Bed-Days)

9 Gross Reduction in 7 Years Phase I by 5 RCHEs Year Year AED Attendance AED Attendance Hospital Utilization Emergency Admissions Emergency Admissions In-patient Bed-Days In-patient Bed-Days AED Attendance AED Attendance Annual Reduction Emergency Admissions Emergency Admissions In-patient Bed-Days NA NA NA Total Phase II by 8 RCHEs Hospital Utilization Annual Reduction In-patient Bed-Days NA NA NA Total Phase III by 12 RCHEs Year Phase IV by 6 RCHEs Year AED Attendance AED Attendance Hospital Utilization Emergency Admissions Hospital Utilization Emergency Admissions In-patient Bed-Days In-patient Bed-Days AED Attendance AED Attendance Annual Reduction Emergency Admissions Annual Reduction Emergency Admissions In-patient Bed-Days NA NA NA Total In-patient Bed-Days NA NA NA Total Overall Reduction of 31 RCHEs ( ) Phase I (5 RCHEs ) Phase II (+ 8 RCHEs) Phase III (+ 12 RCHEs) Phase IV (+ 6 RCHEs) A&E Attendance Emergency Admissions In-patient Bed-Days Total -2,980-3,227-30,328 Data Source: Clinical Data Analysis and Reporting System (CDARS)

10 Average Hospital Utilization Per RCHE Per Month IP beds A&E Attendance (%) Emergency Admissions (%) Bed-Days per resident per month 15.4% 10% 9.9% 5.8%

11 Average A&E Attendance % Per RCHE Data Source: 2011 Clinical Data Analysis and Reporting System (CDARS) 11

12 Hospital Utilization Per RCHE Resident in 2010 Kwai Tsing Kowloon West Cluster Kowloon Central Cluster Kowloon East Cluster New Territories West Cluster New Territories East Cluster Hong Kong West Cluster Hong Kong East Cluster HA Overall A&E attendance per RCHE resident Bed days per RCHE resident Statistics & Workforce Department, Strategy & Planning Division, Hospital Authority Head Office, October 2011

13 Conclusion RCHE Program was effective in: 1. Improved continuity of patient s care in RCHEs 2. Reduced hospital utilization 3. Saved hospital cost 4. Increased job satisfaction both from RCHEs & hospital staffs

14 Key Success Factors for RCHE Program 1. Inspiration 2. Infrastructure 3. Education 4. Evidence

15 Acknowledgement Medicine &Geriatrics (), PMH Dr. LAW C B, CON () Dr. CHUANG L, VMO() PMH Team members Community Nursing Service (CNS), PMH Ms. May CHAN, DOM(CNS) Ms. HEUNG L W, WM(CNS) Ms. YIP T H, APN(CNS) PMH CNS Team members Accident & Emergency (AED), PMH Dr. LIT C H, CON(A&E) Ms. Rebecca SHAM, DOM(A&E) PMH A&E Team members RCHE under program in Kwai Tsing 1. Chung Sing Benevolent Society Lau Mui Hin Home for the Elderly 2. Harmony Home For The Elderly 3. Ho Ho Gerocomy Centre 4. Hong Kong Christian Service Cheung Fat Home for the Elderly 5. Hong Kong Lutheran Social Service Mrs. Leung Kwai Yee Lutheran Home for the Elderly 6. Hong Kong Sheng Kung Hui Lam Woo Home For The Elderly 7. Hong Ning Home For The Aged 8. Kind Heart Elderly Care Limited 9. Kwai Shing East Rhenish Care and Attention Home 10. Oi Tak (Kwai Chung) Old People's Home Limited 11. On Fuk Nursing Home Limited 12. Pak Ho Gerocomy Centre 13. Parklane Nursing Home 14. Pine Care (Po Tak Branch) Elderly Centre 15. Pine Care (Po Tak) Elderly Centre 16. Po Leung Kuk Comfort Court For The Senior 17. Po Sing Old Aged Center 18. Rainbow Elderly Home (Kwai Shing) 19. Rich Heart Limited 20. See Yan Home For Aged 21. Shun Tai Gericare Centre 22. Sun Man Fook Aged Home (Kwai Chung Branch) 23. Sun Man Fook Aged Home Limited 24. Sze Tian Rhenish Home For The Elderly 25. Wah Fung Nursing Centre Limited 26. Welcome Gerocomy Centre 27. Wing On Home For The Aged Limited 28. Yan Chai Hospital Hong Kong Peninsula Lions Club Elderly Home 29. Yan Chai Hospital Artiste Training Alumni Association Care And Attention Home 30. Yan Chai Hospital Chinachem Care And Attention Home 31. Yan Chai Hospital Mrs. Kwok Yuk Cheung Care And Attention Home

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17 Identified Challenges of:

18 RCHE Program since Proactive management of elderly patients across the continuum of HA care 2. Complement CGAS & VMO Service in Kwai Tsing 3. Strengthen service coordination & collaboration CNS DH CHP Medicine & Geriatrics RCHE elderly patients AED Primary Care Social Welfare Department

19 Patient Journey under RCHE Program In PMH Admission Office (Identify RCHE group) AED Admission to designated ward Designated MO 4 Discharge 6 PMH designated MO EM Ward (VMO+ SMO + CNS liaison Nurse ward round) Consultation if needed 5 CNS Post-discharge follow up by CNS within 2-3 working days

20 Outcome Measures (data from HA CDARS) 1. Average A&E attendance per home (%) = Total A&E attendance per month x 100% Total residents number 2. Average emergency admissions (episodes) per home (%) = Total emergency admissions (episodes) per month x 100% Total residents number 3. Average in-patient bed-days (length of stay) = Total in-patient bed-days per month 4. in-patient bed-days per resident per month = Total in-patient bed-days per month Total residents no