- Title
- An exploration of the design and impact of a model of care for acutely unwell older people living in residential aged care facilities
- Creator
- Hullick, Carolyn
- Relation
- University of Newcastle Research Higher Degree Thesis
- Resource Type
- thesis
- Date
- 2022
- Description
- Research Doctorate - Doctor of Philosophy (PhD)
- Description
- People living in Residential Aged Care Facilities (RACFs) in Australia are old, vulnerable, frail and have complex health care needs. This population commonly experiences acute deterioration resulting in transfer to the Emergency Department (ED) where they have longer ED and hospital stays and higher hospital mortality than the broader population. RACF residents also experience increased rates of hospital acquired complications including falls, pressure injuries and delirium, and high rates of invasive intervention. Given the risks associated with hospitalisation for this cohort, it is important that the reasons and benefits of ED transfer are clearly defined. There is a need to establish models of care that continue to ensure access to the ED for older people in RACFs while mitigating the avoidable risks. This thesis by publication traces the evolution of a model of care to support the care of acutely unwell older people living in RACFs in the Hunter New England region of New South Wales, Australia from 2011 to 2020. The model of care focuses on avoiding hospitalisation, whilst delivering clinically appropriate care, in line with the goals of older persons, their carers and families. A research paradigm that supports pragmatic real-world interventions underpins the study. The Sax Institute Translational Research Framework has been used to frame the body of work. Publications about the model of care align to the Translational Research Framework elements from idea generation through to scalability. Consistent with a pragmatic approach, multiple research methods were used to guide the development of and test the model of care. These included focus groups, analyses of pre and post outcomes to pilot the model of care and use of video-telehealth within the model, as well as a cost analysis and a large stepped wedge evaluation. The program of research demonstrated that the model of care was able to reduce ED presentations and hospital admissions thereby generating cost savings. It also demonstrated that an assistant workforce in the ED could undertake screening and provide supportive care. The use of video-telehealth did not demonstrate a significant change in ED presentations or hospital admissions when compared to telephone consultation. The research highlighted the mechanism of the Community of Practice in facilitating clinicians and managers from multiple agencies to work interprofessionally to support research and ongoing development of the ACE program as evidence into practice. It highlighted the need for an integrated health and aged care system, the importance of person-centred care and the need for ED avoidance strategies to ensure alternative access to clinical care for older people who are acutely unwell.
- Subject
- Ooder person; aged Care; community of practice; interprofessional care; models of care; shared decision making; emergency department; residential aged care facility; nursing home; geriatric emergency medicine; stepped wedge design; avoidable hospitalisation; telemedicine; transitions of care
- Identifier
- http://hdl.handle.net/1959.13/1452604
- Identifier
- uon:44460
- Rights
- Copyright 2022 Carolyn Hullick
- Language
- eng
- Full Text
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| Thumbnail | File | Description | Size | Format | |||
|---|---|---|---|---|---|---|---|
| View Details Download | ATTACHMENT01 | Thesis | 8 MB | Adobe Acrobat PDF | View Details Download | ||
| View Details Download | ATTACHMENT02 | Abstract | 373 KB | Adobe Acrobat PDF | View Details Download |