Using AROC Data to Compare Outcomes for Older People in Public and Private Rehabilitation Units

Transcription

1 Using AROC Data to Compare Outcomes for Older People in and Rehabilitation Units AFRM 22 nd Annual Scientific Meeting Adelaide 9-13 September 214 Frances Simmonds, AROC Director Tara Stevermuer, AROC Data Manager

2 EVIDENCE

3 AROC Australasian Rehabilitation Outcomes Centre National rehabilitation clinical registry Australian and New Zealand Established and manages national benchmarking system whose objective is to improve clinical rehabilitation outcomes for patients Promotes the importance of rehabilitation in the continuum of care Almost 1% coverage inpatient rehab units (232 units in Aus, 4 in NZ) AROC receives data describing more than 1, episodes of rehab per year

4 AROC Outputs Routine periodic benchmarking reports Annual AROC Report: the state of the rehabilitation nation National LOS and FIM Change benchmarks Facilitate development of impairment specific outcome targets (workshops) Jurisdictional benchmarking workshops/quality forums Data/data analysis access available for bona fide research Process support/ help desk (resources, verbal advice) Training dataset, FIM, process

5 AROC data Cohort for this study defined as older people, 7 years + In 213 AROC received data for 7,893 episodes for Australian older people 69% of all episodes 61% all Australian episodes for older people are provided in private hospitals

6 Impairment profile by age groups 1% Impairment 9% 8% 7% 6% % 4% 3% 2% 1% % <7 7+ Year Debility Develpomental MultTrauma Other Ortho Congenital Burns Pulmonary Cardiac Other Ortho Ortho Replacement Ortho Fracture Pain Arthritis Amputee Spine Neuro Brain Stroke

7 Data profile for this study Data period Australian episodes 7 years + 4 specific impairments 213, 7 years+ Total Stroke 3,679 1,87,266 Reconditioning 8,363 11,982 2,34 Hip Fracture 3,318 2,46,724 Hip Arthroplasty 1,167 4,76,932 16,27 2,74 37,267

8 Episode Volume by sector 12, 1, Stroke 12, 1, Reconditioning Number of episodes 8, 6, 4, Number of episodes 8, 6, 4, 2, 2, Year Year 12, 12, 1, Hip fracture 1, Hip arthroplasty 8, 8, Number of episodes 6, 4, Number of episodes 6, 4, 2, 2, Year Year

9 % 1% 2% 3% 4% % 6% 7% 8% 9% 1% 29 (n=1,317) 21 (n=1,333) 211 (n=1,337) 212 (n=1,389) 213 (n=1,6) 29 (n=2,396) 21 (n=2,661) 211 (n=2,88) 212 (n=2,946) 213 (n=3,49) Year % 1% 2% 3% 4% % 6% 7% 8% 9% 1% 29 (n=7,87) 21 (n=9,19) 211 (n=1,278) 212 (n=1,833) 213 (n=11,91) 29 (n=3,682) 21 (n=4,37) 211 (n=4,41) 212 (n=,7) 213 (n=8,262) Year % 1% 2% 3% 4% % 6% 7% 8% 9% 1% 29 (n=2,12) 21 (n=2,22) 211 (n=2,14) 212 (n=2,219) 213 (n=2,39) 29 (n=2,6) 21 (n=2,72) 211 (n=2,9) 212 (n=2,993) 213 (n=3,22) Year % 1% 2% 3% 4% % 6% 7% 8% 9% 1% 29 (n=3,469) 21 (n=3,86) 211 (n=3,792) 212 (n=4,141) 213 (n=4,73) 29 (n=97) 21 (n=1,3) 211 (n=1,12) 212 (n=1,187) 213 (n=1,16) Year Stroke Reconditioning Hip fracture Hip arthroplasty AN-SNAP profile by sector

10 1% Age profile by sector 1% 9% 9% 8% 8% 7% 7% Episod es aged 7+ 6% % 4% 9 years and over 8-89 years Episodes aged 7+ 6% % 4% 9 years and over 8-89 years 3% 7-79 years 3% 7-79 years 2% 2% 1% 1% % 3-24 (n=71) 3-2 (n=36) 3-26 (n=493) 3-27 (n=28) 3-28 (n=382) 3-29 (n=) 3-24 (n=83) 3-2 (n=111) 3-26 (n=828) (n=1) (n=1,3) (n=37) Stroke % (n=4,8) (n=,3) (n=2,8) 3-24 (n=22) (n=1,81) (n=2,739) (n=3,448) 3-24 (n=494) Reconditioning 1% 1% 9% 9% 8% 8% 7% 7% Episod es aged 7+ 6% % 4% 3% 2% 9 years and over 8-89 years 7-79 years Episod es aged 7+ 6% % 4% 3% 2% 9 years and over 8-89 years 7-79 years 1% 1% % (n=91) (n=68) (n=64) 3-23 (n=146) (n=79) (n=828) (n=1,231) 3-23 (n=434) Hip fracture % (n=1,33) (n=3,31) (n=41) (n=11) (n=748) (n=311) Hip arthroplasty

11 ALOS by by sector Stroke 3 3 Reconditioning Length of stay Length of stay Priv=71 Pub= Priv=36 Pub= Priv=493 Pub= Priv=28 Pub= Priv=382 Pub=1, Priv= Pub= Priv=4,8 Pub=1, Priv=,3 Pub=2, Priv=2,8 Pub=3, Priv=22 Pub=494 3 Hip fracture 2 Hip arthroplasty Length of stay 2 1 Length of stay Priv=91 Pub= Priv=68 Pub= Priv=64 Pub=1, Priv=146 Pub= Priv=1,33 Pub= Priv=3,31 Pub= Priv=41 Pub=311

12 Average FIM Change by AN-SNAP class by sector, Stroke 2 Reconditioning 2 3 FIM change FIM change Priv=71 Pub= Priv=36 Pub= Priv=493 Pub= Priv=28 Pub= Priv=382 Pub=1, Priv= Pub= Priv=4,8 Pub=1, Priv=,3 Pub=2, Priv=2,8 Pub=3, Priv=22 Pub=494 3 Hip fracture 3 Hip arthroplasty FIM change 1 1 FIM change Priv=91 Pub= Priv=68 Pub= Priv=64 Pub=1, Priv=146 Pub= Priv=1,33 Pub= Priv=3,31 Pub= Priv=41 Pub=311

13 FIM Efficiency by by sector, Stroke 12 Reconditioning Weekly FIM gain 6 4 Weekly FIM gain Priv=71 Pub= Priv=36 Pub= Priv=493 Pub= Priv=28 Pub= Priv=382 Pub=1, Priv= Pub= Priv=4,8 Pub=1, Priv=,3 Pub=2, Priv=2,8 Pub=3, Priv=22 Pub=494 1 Hip fracture 14 Hip arthroplasty Weekly FIM gain 6 4 Weekly FIM gain Priv=91 Pub= Priv=68 Pub= Priv=64 Pub=1, Priv=146 Pub= Priv=1,33 Pub= Priv=3,31 Pub= Priv=41 Pub=311

14 Proportion discharged home by, by sector, Stroke 1 Reconditioning Proportion discharged home.4.2 Proportion discharged home Priv=71 Pub= Priv=36 Pub= Priv=493 Pub= Priv=28 Pub= Priv=382 Pub=1, Priv= Pub= Priv=4,8 Pub=1, Priv=,3 Pub=2, Priv=2,8 Pub=3, Priv=22 Pub= Hip fracture 1.2 Hip arthroplasty 1 1 Proportion discharged home Proportion discharged home Priv=91 Pub= Priv=68 Pub= Priv=64 Pub=1, Priv=146 Pub= Priv=1,33 Pub= Priv=3,31 Pub= Priv=41 Pub=311

15 Casemix adjusted LOS by facility, Length of stay

16 Casemix adjusted FIM Change by facility, FIM change

17 Key Messages Both public and private sectors provide care for the full range of es within each impairment sector admits a higher proportion of people with more complex needs Reviewing outcomes by sector is useful, but only tells part of the story Variation in outcomes at facility level is a key issue

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19 AROC Contact Details Australian Health Services Research Institute (AHSRI) Building 234 (ic Enterprise 1) Innovation Campus University of Wollongong NSW 222 Phone: aroc@uow.edu.au Web: ahsri.uow.edu.au/aroc 19