Vic Management Interns' blog

Blog posts by Victorian Management Interns of the Australasian College of Health Service Management. Views are those of the individual authors and not those of ACHSM or management interns’ host organisations or employers.


Oscar Chaffey
Oscar Chaffey

Health Management Interns, ACHSM

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Better at Home

The COVID-19 pandemic has shone a spotlight on home-based care, although acute home-based care (Hospital in the Home –HITH) was first introduced to Victoria over 25 years ago. The pandemic has acted as a stimulus for radical change within our health sectors funding models and budgets initiatives. The Andrews Labour Government 2020/21 announced the Better at Home initiative as a part of the 2020-21 State Budget in response to the COVID-19 pandemic¹.  The investment will provide a vast range of different care types at home including; acute care (HITH), chemotherapy, post-surgical care, rehabilitation, and telehealth. There are significant opportunities for growth in provision of home-based care services, here are my reflections on these opportunities based on my intern placements.

  1. Standardised clinical pathways to home-based care  

I have observed that there are no standardised clinical pathways to home-based programs and utilisation of these programs is generally dependent on factors like; access to a ‘in hospital’ bed, individual clinician preference and organisational culture. Developing clinical pathways reduces variation in care and increases home-based program utilisation. Clinical pathways ensures that patients can be equally assessed for eligibility to homebased care based on their clinical need and/or their varying social circumstances.  Additionally, having a clear pathway from the commencement of a patients treatment journey sets patients expectations that they can be treated at home, thus facilitating a smooth transfer to the home setting. These pathways could be expanded to be utilised outside the inpatient wards to facilitate a direct entry into home-based programs, avoiding hospital admission completely.  This could include pathways from the Emergency Department, Ambulance Victoria and patient’s primary care GP. Avoiding hospital admission further improves access to beds and is more cost effective then substituting inpatient hospital care².

  1. Consolidate multiple home-based programs within health services

Health services tend to have multiple home based programs that are designed around funding streams rather than individual patient needs. Through redesign these programs can be integrate to improve scale and reduce duplication of effort. This may result in a single central point of patient intake where patients can be effectively triaged to the right care to meet their needs.

  1. Embed technology in home-based care 

I have witnessed health services truly embrace using telehealth and remote patient monitoring (RPM) technology during the pandemic. This should be expanded to home-based services to enable the program to be scaled up without dramatic increase in workforce. This would be particularly advantageous for rural and regional areas where nurses and doctors cannot efficiently travel to patients’ homes to provide care remotely. In addition, expanding remote patient monitoring to home-based programs can enable rapid response to deterioration, and reduces the need to drive to patients for review. Both telehealth and remote patient monitoring promotes environmental sustainability by reducing the number of cars on the road and therefore assist in reducing carbon emissions.

Throughout my placements I have heard first hand that home-based care is affective in lifting access to acute and subacute beds, improves financial sustainability and provides a patient centred approach by delivering care in the comfort of the patients own home. I am excited to witness the expansion of home-based services and the substantive impact on the Victorian Health System. 

References:

  1. Office of the Premier of Victoria. (2020). Better At Home – More Support To Recover At Home [Press Release]. Published 14 November. Retrieved from: https://www.premier.vic.gov.au/better-home-more-support-recover-home. Accessed: 4 April 2021.
  2. Shepperd, S., Iliffe, S., Doll, H. A., Clarke, M. J., Kalra, L., Wilson, A. D., & Gonçalves-Bradley, D. C. (2016). Admission avoidance hospital at home. The Cochrane database of systematic reviews9(9), CD007491. https://doi.org/10.1002/14651858.CD007491.pub2

 

 



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