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
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
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
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
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
% of AED Attendance / Emergency Admission Bed-days per resident per month Average Hospital Utilization Per RCHE 2004 to 2011 20.0% 18.0% 16.0% 14.0% 12.0% 10.0% 8.0% 6.0% 4.0% 2.0% 0.0% 2004 2005 2006 2007 2008 2009 2010 2011 1.40 1.20 1.00 0.80 0.60 0.40 0.20 0.00 AED Attendance Emergency Admission Bed-days per resident per month
AED Attendance / Emergency Admissions (Episodes) In-patient length of stay (Bed-Days) Annual Reduction of Hospital Utilization All RCHEs in Project 0 2005 2006 2007 2008 2009 2010 2011 1000-200 -400-600 -800-1000 -1200 0-1000 -2000-3000 -4000-5000 -6000-7000 -8000-9000 AED Attendance Emergency Admissions (Episodes) In-patient length of stay (Bed-Days)
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 2004 1743 1080 8920 NA NA NA 2005 1520 921 7501-223 -159-1419 2006 1578 887 7281-165 -193-1639 2007 1461 826 6308-282 -254-2612 2008 1472 753 5549-271 -327-3371 2009 1574 813 6615-169 -267-2305 2010 1373 806 7103-370 -274-1817 2011 1191 661 5708-552 -419-3212 2012 329 183 1469-132 -112-1121 Total -2164-2005 -17496 Phase II by 8 RCHEs Hospital Utilization Annual Reduction In-patient Bed-Days 2004 1385 895 9167 NA NA NA 2005 1593 1025 10799 208 130 1632 2006 1462 935 10295 77 40 1128 2007 1503 875 8510 118-20 -657 2008 1228 629 6383-157 -266-2784 2009 1211 607 5600-174 -288-3567 2010 1154 624 6679-231 -271-2488 2011 768 413 4290-143 -143-1643 Total -302-818 -8379 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 2009 1367 912 10542 NA NA NA 2010 1149 708 8159-218 -204-2383 2011 623 387 4210-132 -129-1610 Total -350-333 -3993 In-patient Bed-Days 2010 1013 636 4963 NA NA NA 2011 579 385 3126-164 -71-460 Total -164-71 -460 Overall Reduction of 31 RCHEs (2004-2011) 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 -2164-2005 -17496-302 -818-8379 -350-333 -3993-164 -71-460 Total -2,980-3,227-30,328 Data Source: 2004-2011 Clinical Data Analysis and Reporting System (CDARS)
Average Hospital Utilization Per RCHE Per Month 2004 2011 19 IP beds A&E Attendance (%) Emergency Admissions (%) Bed-Days per resident per month 15.4% 10% 9.9% 5.8% 1.02 0.57
Average A&E Attendance % Per RCHE 2011 4753 4743 4813 4848 4787 4802 4833 4782 4765 4730 4789 4791 2850 2826 2862 2855 2765 2758 3408 3341 3328 3379 3413 3395 Data Source: 2011 Clinical Data Analysis and Reporting System (CDARS) 11
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 2.6 2.8 2.6 2.8 3.0 2.7 2.9 2.8 2.8 Bed days per RCHE resident 14.7 16.0 14.3 13.3 15.3 14.5 17.2 14.9 15.3 Statistics & Workforce Department, Strategy & Planning Division, Hospital Authority Head Office, October 2011
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
Key Success Factors for RCHE Program 1. Inspiration 2. Infrastructure 3. Education 4. Evidence
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
Identified Challenges of:
RCHE Program since 2004 1. 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
Patient Journey under RCHE Program In PMH 1 2 3 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
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