RecruitingACTRN12609000562279

Evaluation of Blacktown Australian Better Health Initiative Integration Project in Improving Continuity of Care in Chronic Cardiac, Respiratory and Aged Care Patients

Evaluation of Blacktown Australian Better Health Initiative (ABHI) Integration Project in Improving Continuity of Care in Chronic Cardiac, Respiratory and Aged Care Patients

Sponsor

WentWest Ltd

Enrollment

100 participants

Start Date

Jul 28, 2009

Study Type

Observational

Conditions

The study aims to achieve continuity of care for chronic cardiac, chronic respiratory and aged patients in the areas of Blacktown, by integrating the services of the hospital, general practitioners and community health services.

Summary

The aim of the outcome evaluation will be to describe changes in the rates of emergency department presentations and hospital admissions associated with the Blacktown ABHI Integration Project, and to explore changes in the processes of patient care in the community that may explain these. The specific objectives will be: 1. To measure the rates of emergency department presentation and hospital admission amongst patients enrolled in the Blacktown ABHI Integration Project, prior to and following enrollment; also to measure contacts with SWAHS Community Health Services durign this time; 2. To explore patients’, carers’ and health professionals’ accounts of how the Blacktown ABHI Integration Project has influenced the care of enrolled patients; and, 3. To develop a detailed, quantified account of the effect of the Blacktown ABHI Integration Project on the processes of care of enrolled patients, and in consequence on their rates of emergency department presentation and hospital admission.

Eligibility

Sex: Both males and femalesMin Age: 18 Yearss

Plain Language Summary

Simplified for easier understanding

This study is looking at how a care coordination program in Blacktown (NSW) affects the health of people with chronic heart, lung, or aged care conditions who are at high risk of coming back to hospital. Care navigators help guide patients through the healthcare system — from the emergency department to community services — to try to keep them healthier and out of hospital. The study will track hospital visits and how well community health services are working for these patients. You may be eligible if: - You have been admitted to Blacktown Hospital with a chronic heart or lung condition, or need aged care - You have been identified as high risk of returning to hospital - You received support from a care navigator during your hospital stay - You live in the greater Blacktown area - You are 18 years of age or older You may NOT be eligible if: - You are under 18 years of age (unless you have a chronic illness requiring aged care) Talk to your doctor about whether this trial might be right for you.

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Interventions

Observational study. We will compare patient presentations and admissions to the emergency department at Blacktown hospital 12 months prior to enrollment into the ABHI Integration project and 6 months following. In particular we will evaluate the date of admission, duration of admission (i.e., bed-days) and discharge diagnoses. We will also investigate the impact on health care in the community. The date of death of any patient participant who dies during the six months following enrollment will be recorded. At recruitment into the evaluation, and again one and six months later, each patient participant will be asked to complete the EQ-5D health status measure1. This is a generic measure of health status that is applicable to a wide range of chronic diseases.

Locations(1)

Australia

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ACTRN12609000562279