Abstract
Background: Patients with chronic and complex care needs are at risk of fragmented care during the transition from hospital to the community. The Western Health catchment includes a culturally and linguistically diverse population with almost half speaking a language other than English at home. The catchment experiences significant socio-economic disadvantage and increased levels of chronic disease. Improving organisation of care delivery for this population has great potential for reducing health inequities. An integrated care-based intervention at Western Health, in Western Melbourne, Australia has been trialled to support patients during the transition from hospital to the community. Understanding patients’ experiences is an essential component of the intervention’s assessment.
Approach: An Integrated Care Committee at Western Health, chaired by the chief executive officer, helped to develop shared values and vision by engaging with over 1000 community members including patients and carers. This, in addition to case reviews and literature review, led to multiple factors being identified that predispose to successful integrated care models. These were incorporated when designing a new organisation of care delivery, Western HealthLinks, an integrated care pilot program supported by the Victorian State Department of Health and Human Services (DHHS) and run in conjunction with community partner, Silverchain, to support patients with chronic and complex care needs at high risk of hospital readmission. Patients at high risk were identified using a digital solution, an electronic technology algorithm using electronic medical records for risk stratification, and were supported in their hospital to community transition, with an integrated care model including ongoing community-based care including tele-health follow-up. The aim of this study was to understand patients’ experiences of the intervention using a survey regarding healthcare experience, a visual analogue scale (VAS) measuring satisfaction with healthcare and the Assessment of Quality of Life Four Dimensions (AQoL4D) instrument assessing health related quality of life (HRQOL). Survey responses were coded by researchers and assessed with a thematic analysis to identify major themes.
Results: At baseline, median VAS assessing healthcare satisfaction was 79/100 and median AQoL4D was 0.15 (minimum possible score -0.04, maximum 1). Although healthcare satisfaction and HRQOL were expected to decline over time given the increasing burden of disease with advancing age, there was no clinically significant change to VAS or AQoL4D over time. Important themes identified across timepoints included: Local/home-based care; hospital access; individualised, coordinated and consistent care; communication; reduced waiting; healthcare provider qualities; transport/parking.
Implications: Western HealthLinks is an integrated-care model incorporating shared values and vision, with potential to reduce health disparities using a digital solution to identify patients at high risk of readmission by providing patient-centred support peri-discharge including telehealth follow-up and other community delivered care. Western HealthLinks patients maintained healthcare satisfaction and QoL over time. The themes identified from patients’ healthcare experiences highlighted that patients value integrated care. Patient survey data has been used to inform subsequent iterations of the Western HealthLinks program, seeking to ensure the program delivers people-centred care. Other future models of care may also benefit from consideration of the themes which emerged from this analysis.