Author Identifier (ORCID)
Judith Dianne Pugh
ORCID : 0000-0002-1835-1330
Margaret Giles
ORCID : 0000-0002-3260-6811
Abstract
Neurological disorders are a leading cause of disease burden worldwide, placing a heavy demand on health systems. This study evaluated the impacts and cost savings of a community-based nursing service providing supported discharge for neurological patients deemed high-risk for unplanned emergency department presentations and/or hospital readmissions. It focused on adult patients with stroke, epilepsy, migraine/headache or functional neurological disorders discharged from a Western Australian tertiary hospital. An observational design was used comprising prospective enrolment of patients receiving nurse-led supported discharge and follow-up (Neurocare), 21 August 2018 to 6 December 2019 (N = 81), and hospital administrative data, 1 February 2016 to 31 January 2018, for patients in previous care model (N = 740). Healthcare utilisation and annualised cost savings from reduced rehospitalisation and/or emergency department presentations within 28 days post discharge were compared. Neurocare patients’ postdischarge functional and health-related quality of life outcomes, and perceived involvement in self-management and integrated care were surveyed. The hospital's total cost savings are A$101,639 per annum and A$275/patient/year with a return on investment of 2.01. There was no significant difference in hospital length of stay (LOS) between models, but older age was associated with longer length of hospital stay and a predictor for non-neurological readmissions. Neurocare patients showed improved functional status, less equipment and/or service needs, improved health-related quality of life. They felt involved in self-managing their condition with well-integrated postdischarge care. This nurse-led model of transitional care for neurology patients discharged from hospital produced cost savings and a positive return on investment compared with usual care. With service maturity, earlier supported hospital discharge and reduced LOS may follow. Patients’ reduced service needs and improved functional status and health-related quality of life may positively impact healthcare utilisation. Future research should include larger patient samples and multiple sites.
Keywords
continuity of patient care, economics, hospitals, aftercare, neuroscience nursing, nursing, program evaluation, quality of life
Document Type
Journal Article
Date of Publication
7-31-2022
Publication Title
Health and Social Care in the Community
Publisher
Wiley
School
School of Nursing and Midwifery / School of Arts and Humanities
RAS ID
37026
Funders
Department of Health, Western Australia
Comments
This is an Author's Accepted Manuscript of:
Pugh, J. D., McCoy, K., Needham, M., Jiang, L., Giles, M., McKinnon, E., & Heine, K. (2022). Evaluation of an Australian neurological nurse‐led model of postdischarge care. Health and Social Care in the Community, 30(4), e962-e973.
https://doi.org/10.1111/hsc.13498