Service Model Options


Understanding long-term care services for older people with cognitive decline in Australia

Maria Crotty

Lead Investigator: Professor Maria Crotty

The aim of this program is to provide aged care providers and health decision makers throughout Australia with a measure of the cost of providing quality care to people with dementia, enabling them to plan services and shape policy more effectively and efficiently. This activity will provide information on the costs of residential aged care provided for people with cognitive decline across a range of care services. An Australian consumer derived measure around choice and quality of care will be developed and the results will allow for international comparisons.

The project team will collect detailed information on resource use, decision making, implementation of dementia specific interventions, environmental settings and service use data to enable comparison of current care service models. Further, the team will examine service characteristics and outcomes of hospital care for people with cognitive decline and administrative data will be used to model the undeclared cost and burden of dementia care in the hospital system.

Examination of current services for dementia care will inform modelling and testing of possible future approaches to care of those with cognitive decline. Focusing on residential facilities, acute care and community care the team will examine innovative models of dementia care, which promise to improve quality of life and health outcomes, increase consumer choice, provide access to
evidence based treatments for dementia and reduce whole of system costs.


The Care of Confused Hospitalised Older Persons (CHOPs) Program Implementation

Professor Susan Kurrle

Lead Investigator: Professor Susan Kurrle

The Care of Confused Hospitalised Older Persons (CHOPs) program is designed to enable staff to have the skills and knowledge to identify, treat and care for older people presenting to their hospitals with confusion.

‘Confusion’ is the lay term given to cognitive impairment. Confusion is not a normal part of ageing. The main people affected are those with dementia, delirium and depression. Dementia is usually a gradual, progressive decline, with Alzheimer’s disease being the most common type, whereas delirium is an acute fluctuating disturbance of consciousness and attention caused by a variety of illnesses and care practices. People with dementia are at greater risk of developing delirium when they are unwell and in hospital.

Cognitive impairment is common in hospitals and will increase as the population ages. There is strong evidence that people with cognitive impairment do worse in hospitals than those without it. They are more likely to develop complications such as pressure injuries, decline in their ability to look after themselves, or have an adverse event such as a fall. They are more likely to die, or be in hospital for longer and be admitted to residential care from hospital.

These outcomes can be improved with better identification, prevention and treatment of delirium, and more appropriate care of people with dementia.

During this project the original key principles identified in the pilot study have been developed into the Key Principles for Care of Confused Hospitalized Older Persons

CHOPs

To date the CHOPs program has been implemented in 13 hospital sites across NSW with baseline data collected for all 13 sites.

A CHOPs website focusing on implementation support has also been developed and provides an invaluable detailed resource of any hospital site interested in implementing the CHOPs program.


The cost-effectiveness of aged care, dementia and dementia management in Australia

Lachlan Standfield
Tracy Comans

Lead Investigators: Dr Tracy Comans and Mr Lachlan Standfield

Health care systems have limited resources and require choices to be made regarding the allocation of these resources to ensure these systems remain efficient and sustainable. Financial resource allocation can be made arbitrarily, through market mechanisms, or they may be guided through formal cost-effectiveness analyses (CEA). CEA is a form of economic analysis where both the costs and consequences of health programmes or treatments are examined and quantified.

This PhD research project explored a range of economic modelling methods to assess the cost-effectiveness of the health care system and the impact of constrained resources as they relates to aged care, dementia and dementia care in Australia with the aim of developing a discrete event simulation based economic model to determine the impact of resource constraints and queuing on the efficiency of the health care system as it pertains to aged care, Alzheimer’s and dementia management.

The outcomes contained in the final thesis included costs, patient preference-based health-related quality of life (utility), cost-effectiveness, queuing times and patient flows through various resources.

Publications

Standfield, L. B., Comans, T., & Scuffham, P. (2017). A simulation of dementia epidemiology and resource use in Australia. Australian and New Zealand Journal of Public Health


A person centered volunteer program to improve the care and outcomes for older people with dementia and/or delirium in acute settings

Katrina Anderson
Annaliese Blair
Cath Bateman

Lead Investigators: Ms Cath Bateman, Ms Annaliese Blair and Dr Katrina Anderson

This project recruited and trained volunteers across 9 rural hospitals in Southern NSW Local Health District. The volunteers were trained to provide one-to-one practical assistance and emotional support for people with dementia and/or delirium in acute hospitals. The volunteers provided person centred care with a focus on nutrition and hydration support, hearing and visual aids, activities, and orientation. This was underpinned by their completion of a personal profile with the patient and/or their carer, where volunteers gained important knowledge about the person’s back ground, family and personal preferences. In a practical sense, this assisted volunteers in their connection and communication with patients, an understanding of their abilities and a way to support their choices in food preferences and provide meaningful activities.

The study was an expansion of a pilot volunteer program conducted at Bega Hospital, NSW in 2009. The pilot program found acceptance of the program by staff and volunteers and a trend towards reduction in falls in the intervention group. The program became embedded in the facility and has been sustained for 9 years.

The project found that cross all sites, for patients who received volunteer care, there was a significant reduction in rates of 1:1 special care provided by a nurse or security staff. There was also a reduction in the number of patients who were readmitted to hospital within 28 days. The length of hospital stay was significantly shorter for the control group. There were no other differences in patient outcomes such as falls, death rates and behavioural incidents between the intervention and control groups.

Family carers, staff and managers reported that volunteers became a valuable part of the care team. They provided person centred care, supporting increased quality of physical and emotional care for patients and reduced burden for staff and families. Staff reported some minor initial boundary issues that were quickly ironed out. Once trained and embedded, staff reported that volunteers assisted them in their work. All staff and families wanted to see the program continue.

Implementation resources

If your organisation is interested in implementing the program, all program resources are freely available for downloading:

Implementation training

Volunteer Program Information


Validating and evaluating a quality of life (QOL) instrument for people with dementia

Kim Nguyen
Tracy Comans

Lead Investigators: Dr Tracy Comans and Dr Kim-Huong Nguyen

Cost-effectiveness is an essential part of the decision making process for governments when assessing whether new drugs, devices and health care are worth paying for.

The most common form of cost-effectiveness analysis used in health care relies on accurate estimates of the quality of life of the person receiving the health care intervention. It is common to use generic quality of life instruments to generate utility values for economic evaluation. These commonly measure limitations in domains such as mobility, self-care, usual activities and pain. However, these are not suitable for valuing health states in dementia as they do not capture additional aspects of quality of life that are important to people with dementia, such as family role, social relationships and memory.

Disease specific measures of quality of life that are better at capturing domains relevant to people living with dementia have been developed e.g. quality of life-Alzheimer’s Disease instrument (QOL-AD), however these instruments are not suitable in their usual form for use in economic evaluation and require conversion to a preference based instrument in order to generate utility values.

We propose undertaking a world first valuation of dementia health states using the QOL-AD instrument for use in economic evaluation. This will be the first work in Australia developing utility scales for dementia specific measures. This will result in instruments that will be immediately transferable into current research and will inform future planning and resource allocation for dementia care.