Greg Merlo, AusHSI Research Fellow, Health Economics
On 23rd August 2017 AusHSI is launching the white paper Taking Healthcare Home: Overview of findings and recommendations. The paper, which will be presented at the Australasian College of Health Services Management (ACHSM) Queensland Forum, outlines the key success factors that determine and impede the quality use of healthcare in the home services.
The paper reports the findings of AusHSI’s Taking Healthcare Home Forum held earlier this year. The Forum explored public health policy issues related to healthcare in the home in the Queensland context for three services: hospital in the home (HITH); home dialysis; and, home parenteral nutrition (HPN).
Potential benefits of the provision of healthcare at the patient’s home include improved health outcomes, increased patient and carer satisfaction, and reduced costs. The benefits depend on the disease, the nature of the service, and the model of care.
The Forum was designed to identify the key factors that were impeding healthcare in the home services, and to facilitate stakeholder discussion around how to improve the quality and uptake of home healthcare. The forum was divided into two phases.
The first phase, in the morning, included presentations and an interactive discussion panel with experts in the field. The second phase, in the afternoon, was a World Café to facilitate the sharing of ideas. The World Café brought together clinicians, hospital administrators, policymakers, and consumers to take a collaborative approach to identifying opportunities to increase the uptake of healthcare in the home.
Five factors that determine the quality use of healthcare in the home services were identified:
- Financial incentives and funding for healthcare in the home—make incentives explicit and transparent; have clear funding pathways; recognise patient costs
- Awareness—identify and address knowledge gaps for patients and providers; incorporate healthcare in the home training at orientation and as part of tertiary education
- Professional culture and attitudes—measure and publicise safety and quality data; clearly define governance models and role delineation; enlist Clinical Nurse Consultants (CNCs) dedicated to HITH at ED to educate and advocate
- Technology—maximise use of existing resources; improve integration and access to health records; utilise and invest in decision support systems; schedule regular training for new and existing technology
- Needs of patients and carers—improve and standardise home suitability assessment; provide after-hours telephone assistance and respite for carers; address financial burden to patients; review existing training materials
There are significant differences between HITH, home dialysis, and HPN. Despite this, the discussion and World Café identified ways in which government policy, private business, and research could work together to enable home healthcare and allow it to thrive. Home health may not be an option for all patients, but when appropriate, it can lead to improved outcomes, lower costs, and greater capacity. This paper presents the key themes and recommendations that stakeholders and experts have identified as the key to successful home healthcare.