A longitudinal cohort study evaluating the impact of a geriatrician-led residential care outreach service on acute healthcare utilisation

Background: over the last decade, high demand for acute healthcare services by long-term residents of residential care facilities (RCFs) has stimulated interest in exploring alternative models of care. The Residential Care Intervention Program in the Elderly (RECIPE) service provides expert outreach services to RCFs residents, interventions include comprehensive care planning, management of inter-current illness and rapid access to acute care substitution services. Objective: to evaluate whether the RECIPE service decreased acute healthcare utilisation. Design: a retrospective cohort study using interrupted time series analysis to analyse change in acute healthcare utilisation before and after enrolment. Setting: a 300-bed metropolitan teaching hospital in Australia and 73 RCFs within its catchment. Subjects: there were 1,327 patients enrolled in the service with a median age of 84 years; 61% were female. Methods: data were collected prospectively on all enrolled patients from 2004 to 2011 and linked to the acute health service administrative data set. Primary outcomes change in admission rates, length of stay and bed days per quarter. Results: in the 2 years prior to enrolment, the mean number of acute care admissions per patient per year was 3.03 (SD 2.9) versus post 2.4 (SD 3.3), the service reducing admissions by 0.13 admissions per patient per quarter (P = 0.046). Prior to enrolment, the mean length of stay was 8.6 (SD 11.0) versus post 3.5 (SD 5.0), a reduction of 1.5 days per patient per quarter (P = 0.003). Conclusions: this study suggests that an outreach service comprising a geriatrician-led multidisciplinary team can reduce acute hospital utilisation rates.