Wednesday, June 4, 2014

Hospital care vs. home care, ALC patients

According to CIHI’s OurHealthSystem

It costs an average of $5,335 to stay in at a Canadian Hospital during 2011 to 2012.
Lowest:                Quebec $4,728
Average:              Nova Scotia, $5,384
Highest:               Yukon $7,394

Hospital at Home not cheaper than in-hospital care

Conclusions: This review does not support the widespread development of "hospital at home" services as a cheaper substitute for in-patient care within health care systems that have well developed primary care services. On the other hand, it does not recommend discontinuation of existing programs for patients with terminal illne

ss, elderly medical patients, or following elective surgery. If the costs of running local hospitals are relatively high (e.g. teaching hospitals), hospital at home may provide a cost effective alternative.
Reference: Shepperd S and Iliffe S. Hospital at home versus in-patient hospital care. The Cochrane Database of Systematic Reviews 2002; 4.

Alternative Level of Care: Canada's Hospital Beds, the Evidence and Options

Hospital Bed Use: The Case of Alternative Level of Care

What do we know about ALC patients? The data tell us that over 50% of ALC patients are eventually discharged to facility-based post-acute care (CIHI 2010b). The remainder of patients are discharged to assisted living or to their homes (with or without support). Over 35% of ALC patients are 85 years or older, and nearly a quarter of ALC patients have been diagnosed with dementia (CIHI 2011b).
In terms of resources, ALC patients consumed the equivalent of 2.4 million hospital days over the course of fiscal year 2008/09; the equivalent of approximately 7,500 beds are occupied by a patient designated as ALC on any given day (CIHI 2010b). On average, one ALC patient occupying a bed in the emergency department denies access to four patients per hour to that emergency department (Canadian Association of Emergency Physicians 2005).
We also know that waiting in hospital for post-acute care prolongs patients' exposure to an environment that experiences thousands of avoidable adverse events each year (Baker et al. 2004). Moreover, delays in discharges, particularly for frail geriatric patients, can lead to rapid deterioration in health, eventually requiring additional acute care or necessitating premature admission to long-term care (Canadian Healthcare Association 2009).

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