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Australia needs innovative solutions and new public health promotion measures to cope with the increasing demand for hospital care caused by an ageing population and an increase in chronic diseases.
Australia is likely reaching the limit of how the length of stay in hospital can be safely reduced, according to new research.
The research, published today in The Medical Journal of Australia, shows that containing hospital costs by limiting bed availability and reducing length of stay may no longer be a viable strategy.
Dr Natasha Reid, a research fellow and clinical epidemiologist at the Centre for Health Services Research at the University of Queensland, and her colleagues Thakeru Gamage, Dr Stephen Duckett, and Professor Leonard Gray, reviewed hospitalisation data from the Australian Institute of Health and Welfare (AIHW).
“We are likely reaching the limit of how much we can safely reduce length of stay in hospital using current health care models,” Dr Reid said in an interview with InSight+.
The burden of an ageing population and chronic diseases
The burden of Australia’s ageing population will continue to put demand on hospital systems, the research found.
“For the first time in history, there are more people aged 65 years and over than there are aged under 5 years,” Dr Reid said.
“The data are starting to indicate that we may not be able to further reduce length of stay using existing methods, and that hospital administrators need to start thinking about and educating themselves on what other solutions could be implemented.”
What needs to happen
Australia needs to start identifying other strategies that will help ease pressure on the acute care sector, Dr Reid said.
“Integrating technology (such as mobile health or remote monitoring) and investing in health promotion are just two potential avenues,” Dr Reid said.
Health systems need to be seriously considering how to adapt their operations to managing both an ageing population and chronic diseases, she said.
“Ageing and chronic disease management are core business in health care, and innovative solutions are needed to improve outcomes,” Dr Reid said.
Professor of Geriatric Medicine Leonard Gray, who co-authored the piece, said that one potential solution is increasing hospital capacity.
“One other solution to burgeoning demand related to population ageing is simply to build greater hospital capacity,” Professor Gray told InSight+.
“That is, more beds and significantly greater expenditure on hospital care.
“Until now, demand for beds has been controlled by reductions in length of stay for older people, with associated reductions in age specific bed utilisation.
“Logically, this cannot continue indefinitely, as the length-of-stay declines towards that of younger patients (which seems immovable, based on our observations).
Learning from overseas
Australia needs to look at what is being done internationally to help manage hospital admissions, Dr Reid said.
“Health services [overseas] have implemented solutions like expanding hospital at home programs, having dedicated emergency department processes and specialised wards for those who are frail,” she said.
For example, in the UK, many hospitals have implemented a Frailty at the Front Door service, aiming to improve the experience and outcomes of people with frailty who present at emergency.
Dr Reid said she and her colleagues were driven by the wish to positively impact the health of Australians.
“For as long as I can remember, I have wanted to positively impact the health and wellbeing of populations through evidence-based programs and health service design,” she said.
“The acute care/tertiary hospital sector is an area of huge potential because it is a necessary service, hugely expensive for government, and where we can create beneficial health, social, and financial impact.”
Read the research in The Medical Journal of Australia.
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It is fascinating that once again, the NHS model of care is being quoted as a potential solution. Has nobody been reading the news, watching the TV or reading the avalanche of articles in the press and on the internet testifying that the NHS is now broken? Not about to break, but broken. There are years-long waiting lists, rolling strikes by doctors and nurses, ambulance ramping, and only functioning at all by the ethically dubious plundering of developing countries for their nurses and doctors and other health care professionals. Obviously even in a crumbling structure there will still be islands of ‘quality’ not to mention an abundance of administrators bragging about them. But overall the NHS can teach us nothing.
Just
Invest
Properly
In
Primary
Care
We need to take a deep look into the culture of health that got us here to this place, and how this has shaped a system framed around biological disease rather than human health. Until we acknowledge the cultural problem, reforms will simply get hijacked to serve the system like they always are. Politicians need to stop protecting the system and start demanding the outcomes communities want. Politicians need to stand back and acknowledge that they are like drowning sailor at sea, tying their fortunes to an anchor (hospitals) and ignoring the life boats all around (community health and social care).
Building bigger hospitals is unlikely to solve the issues – given the difficulties in staffing them!. I think looking at ways to support patients to do more for them selves with remote support would be helpful. And we also need to look at the whole person in managing older and frail people – we should stop doing things to people (just because we can) without thinking through whether the investigations /treatments will make a difference and whether the person who is in receipt of the care will actually gain net benefit. In my experience we overtreat many because we don’t stop and properly get to know in detail the person who has the condition.
In our modern world we are prompted constantly to check symptoms, have screening tests, see our doctor if we have any of the following etc etc. The mass media is full of this, but the problem is prompt access. GPs are so busy that same day appointments are nigh impossible, waits of a week or more are not uncommon, and there is the issue of out of pocket costs. Hence worried patients present to EDs and increase the congestion and backlog in our public hospitals. EDs exist partly to triage for serious problems and expecting patients to know when their problem is, or is not serious is unrealistic and at times dangerous. In terms of screening, FOBT and PSA testing, eg. often fail in effectiveness because of poor or delayed access to the appropriate facilities in the public hospital system
Queensland Health is undergoing major reform to alleviate these problems- and to improve patient care- via employing Physician Assistants and setting up Rapid Access Services (for predictable exacerbations in known patients with chronic disease.) University-trained Physician Assistants perform supervised well-defined clinical and administrative tasks to streamline care and to reduce burden on doctors. The Rapid Access model mandates patients have a phone number to call (to their treating team), to bypass DEMs altogether and be assessed or seen by clinicians who know both them, and their care plans. Can prevent admissions and can reduce time in hospital. Reduces ambulance ramping, delays in DEM and bed block, improves patient care and reduces their anxiety. Current DEM issues arise from the model of care which provides only one door into the Hospital for unplanned care. The scope of care in any DEM should be for emergencies- trauma, critically ill, toxicology and unknown patients.
Health is not something provided by government, it is achieved by purposefulattention to healthy lifestyle. Put attention on lifestyle coaching and reduce the biggest sickness of all – dependency on the state by insisting on meaningful co-payments for all medical interventionsl, particularly pharmaceuticals.
I can’t help but wonder if a well-resourced primary care system would help prevent patients needing admission in the first place.
When we focus our resources on the end-stage of severe acute illness, we hear great election promises and dramatic “fixes” for severe acute illness. Unblockers of arteries, platers of broken bones, fixers of infections and their ilk are very visible, highly valued and well-rewarded whereas the cholesterol and blood-pressure reducers, the grab-railers and immunisers’ work is invisible to the public and, it seems, the health economists and planners.
Even putting primary care practitioners into “acute care” settings seems to represent a cheaper closing of the doors behind bolting horses.
What we invest most heavily in, is what we get most of.
If GPs were conspicuously driving cars like cardiologists, boating like bone-docs, flying up the pointy-end in the consultant-class club seats, maybe then we’ll attract enough to do the work that’s invisible, un-noticed and under-valued even when we’re performing at our best.
How do the authors consider the possibility that the primary care/community/preventative/rural health sectors might be areas of even greater potential because they are necessary services, provide savings for government, and where we can create beneficial health, social, and financial impact?
We need more price signals that encourage greater personal investment in healthy lifestyles. One way is to start means-tested charging for what is perceived as “free” healthcare. The other is to expand the range of harmful items that are taxed, beyond tobacco and alcohol. The extra revenue could be spent on health education and additional healthcare services, especially community-based as an alternative to hospitals.
Good review. The ideals are of course not new. What we lack as always is implementation leadership. While average length may be overall ok, there is a lot to be gained by aiming for the top quartile. Remember half hospitals are below average! John