TY - JOUR
AU - B. Shannon
AU - T. Collyer
AU - K. A. Bowles
AU - C. Williams
AU - T. Ravipati
AU - E. Deighton
AU - N. E. Andrew
A1 - 
AB - BACKGROUND: This study aimed to evaluate the impact of the Community Care Program, which was the amalgamation of three outreach services-post-acute care, Residential In-Reach, and the Hospital Admission Risk Program-into a single integrated care model. Specifically, we assessed its effects on unplanned hospital readmissions and emergency department re-presentations at 30-, 60- and 90-days post-enrolment. METHODS: A pragmatic, real-world, population-based observational study was conducted using an interrupted time series analysis. The study included 4708 adult patients across two periods: pre-amalgamation (November 2014-October 2016), and post-amalgamation (May 2017-October 2018). Data were sourced from the National Centre for Healthy Ageing Data Platform, with statistical analyses conducted using Generalised Least Squares models to account for autocorrelation. RESULTS: The study observed a significant increase in quarterly program enrolments post-amalgamation, from 578 to 1011 per quarter. The 30-day readmission rate decreased from 11.8% to 8.52% post-amalgamation. However, interrupted time series analysis revealed no statistically significant changes in the slopes of readmission and emergency department re-presentation rates after the program's amalgamation. The program did not result in significant changes in 60- or 90-day outcomes. CONCLUSIONS: The amalgamation of post-acute care, Residential In-Reach, and the Hospital Admission Risk Program into the Community Care Program led to increased service utilisation without a significant impact on reducing unplanned hospital readmissions or emergency department re-presentations. Although the program amalgamation demonstrated improved accessibility, its longer-term impact remains inconclusive, highlighting the need for continuous refinement and further evaluation to optimise system efficiency. No patient or public contribution occurred in this study. REPORTING METHOD: This study adhered to the STROBE guidelines for observational research.
AD - Department of Paramedicine, Monash University, Melbourne, Victoria, Australia.; Peninsula Clinical School, Central Clinical School, Monash University, Melbourne, Victoria, Australia.; National Centre for Healthy Ageing, Monash University and Peninsula Health, Frankston, Victoria, Australia.; School of Primary and Allied Health Care, Monash University, Frankston, Victoria, Australia.; Community Care, Peninsula Health, Frankston, Victoria, Australia.
AN - 39930065
BT - J Adv Nurs
C5 - Healthcare Disparities
CP - 10
DA - Oct
DO - 10.1111/jan.16808
DP - NLM
ET - 20250210
IS - 10
JF - J Adv Nurs
LA - eng
N2 - BACKGROUND: This study aimed to evaluate the impact of the Community Care Program, which was the amalgamation of three outreach services-post-acute care, Residential In-Reach, and the Hospital Admission Risk Program-into a single integrated care model. Specifically, we assessed its effects on unplanned hospital readmissions and emergency department re-presentations at 30-, 60- and 90-days post-enrolment. METHODS: A pragmatic, real-world, population-based observational study was conducted using an interrupted time series analysis. The study included 4708 adult patients across two periods: pre-amalgamation (November 2014-October 2016), and post-amalgamation (May 2017-October 2018). Data were sourced from the National Centre for Healthy Ageing Data Platform, with statistical analyses conducted using Generalised Least Squares models to account for autocorrelation. RESULTS: The study observed a significant increase in quarterly program enrolments post-amalgamation, from 578 to 1011 per quarter. The 30-day readmission rate decreased from 11.8% to 8.52% post-amalgamation. However, interrupted time series analysis revealed no statistically significant changes in the slopes of readmission and emergency department re-presentation rates after the program's amalgamation. The program did not result in significant changes in 60- or 90-day outcomes. CONCLUSIONS: The amalgamation of post-acute care, Residential In-Reach, and the Hospital Admission Risk Program into the Community Care Program led to increased service utilisation without a significant impact on reducing unplanned hospital readmissions or emergency department re-presentations. Although the program amalgamation demonstrated improved accessibility, its longer-term impact remains inconclusive, highlighting the need for continuous refinement and further evaluation to optimise system efficiency. No patient or public contribution occurred in this study. REPORTING METHOD: This study adhered to the STROBE guidelines for observational research.
PY - 2025
SN - 0309-2402 (Print); 0309-2402
SP - 6578
EP - 6588+
ST - Assessing the Impact of an Integrated Community Care Program on Unplanned Hospital and Emergency Department Representations: Interrupted Time Series Analysis
T1 - Assessing the Impact of an Integrated Community Care Program on Unplanned Hospital and Emergency Department Representations: Interrupted Time Series Analysis
T2 - J Adv Nurs
TI - Assessing the Impact of an Integrated Community Care Program on Unplanned Hospital and Emergency Department Representations: Interrupted Time Series Analysis
U1 - Healthcare Disparities
U3 - 10.1111/jan.16808
VL - 81
VO - 0309-2402 (Print); 0309-2402
Y1 - 2025
ER -