Sub-acute modelling in Victoria

Dr Connie Spinoso

7 April 2011

Victoria’s subacute service system

Diverse range of admitted and ambulatory services that:

Support patients to maximise independence and functioning and minimise long term health and community care needs

Promote seamless services across the care continuum from acute to community care

Improve outcomes and avoid functional decline in frail elderly and those with multiple co-morbidities and complex care issues

Services that can provide alternative to hospital care

The subacute service system

Subacute bed based services

• Rehabilitation (adult and paediatric)

• Geriatric Evaluation and Management

• Palliative Care Services

Subacute ambulatory services

• Subacute Ambulatory Care Services

• Community Palliative Care services

34,000 separations (2009-10)

63,000 clients (2009-10)

Subacute Services Planning Framework

Planning the future of Victoria’s subacute service system: A capability and access planning framework (2009)

To establish a process to guide planning towards equity of access and consistency of service quality in sub-acute services across Victoria.

• consistent and comparable information on types and location of services

• Identify service gaps at sub-regional, regional and state level

• Develop explicit standards of service provision and support benchmarking of like services

• Establish expectations around referral and clinical support

Subacute demand

Models of Care

Regional Self-Sufficiency

Burden of Disease

Demographic Change

Acute Activity Increase

Level 5 Services

SUB-ACUTE DEMAND

Latent Demand

Population-based Factors Service Delivery Framework

Growth in subacute separations

0

5,000

10,000

15,000

20,000

25,000

30,000

35,000

2000 2001 2002 2003 2004 2005 2006 2007 2008 2009

Sepa

ratio

ns

GEM seps

Rehab seps

Pallv seps

SACS

Average length of stay

0.0

5.0

10.0

15.0

20.0

25.0

30.0

35.0

2000 2001 2002 2003 2004 2005 2006 2007 2008 2009

Aver

age

leng

th o

f sta

y

GEM ALOS

Rehab ALOS

Pallv ALOS

Modelling subacute activity

Clinical Related Groups

Level 1 rehabilitationLevel 2-3 rehabilitationGEM – strokeGEM – rehabilitationGEM – other

VAED is divided according to the forecast variables shown on right.

CRG

0-14 Same day Male

15-44 Multi day Female

45-69

70-84

85 +

Modelling subacute activity

Traditional forecastCalculate utilisation rate for each group (separations per 1,000 population)Linear projection of utilisation rate as shown below

0.00

0.501.00

1.502.00

2.503.00

3.504.00

4.50

5.00

2000 2004 2008 2012 2016 2020 2024 2028

Util

isat

ion

rate

Year

Past utilisation Forecast utilisation

Modelling subacute activity

Traditional forecast (ALOS)Group length of stay as per sub-groups shown previouslyCalculate Average Length of Stay (length of stay / separations)Forecast ALOS using log, linear/exponential smoothing model

0.00

2.00

4.00

6.00

8.00

10.00

12.00

2000 2004 2008 2012 2016 2020 2024 2028

Aver

age

leng

th o

f sta

y (d

ays)

Year

Variable Combination 1

Variable Combination 2

A new approach

Calculate expected catchment demand

Adjust demand for inflows and outflows

Determine gap between supply and demand

A new approach

Calculate expected catchment demand

A. public acute to public sub-acute flow

B. private acute to public sub-acute flow

C. admissions direct from community and other non-acute care

D. Expected demand = A + B + C

Modelling subacute activity

New methodUses transfer rates from acute so that the volume of acute activity determines future subacute activity

Uses linked VAEDTransfer rates by MCRG

MCRG Acute multi-day seps (last 3 yrs)

Transfers to subacute

Transfer rate

Orthopaedic 140,673 18,314 13.0%

Neurology 76,718 8,231 10.7%

Vascular 22,645 1,372 6.1%

A new approach

E. adjust for net regional flow

F. adjust for interstate flow

G. Adjusted demand = D + E + F

Adjust demand for inflows and outflows

A new approach

H. Calculate utilisation of current supply

I. Gap = H - G

Determine gap between supply and demand

Gap between supply and demand (catchments)

Forecasting outcomes

Rehabilitation level 2-3

0

10,000

20,000

30,000

40,000

50,000

60,000

2001

2003

2005

2007

2009

2011

2013

2015

2017

2019

2021

2023

2025

2027

Sepa

ratio

ns

New seps

Traditional seps

Forecasting outcomes

GEM rehabilitation

0

500

1,000

1,500

2,000

2,500

3,000

3,500

4,000

4,500

5,000

2001

2003

2005

2007

2009

2011

2013

2015

2017

2019

2021

2023

2025

2027

Sepa

ratio

ns

New seps

Traditional seps

Forecasting outcomes

Average length of stay

0.0

5.0

10.0

15.0

20.0

25.0

30.0

35.0

2000 2002 2004 2006 2008 2010 2012 2014 2016 2018 2020 2022

GEM ALOS

Rehab ALOS

Pallv ALOS

National Partnership Agreements

National Partnership Agreement on Hospital and Health Workforce Reform (2008) and Improving Public Hospital Services (2011)

Increase subacute services across Victoria by 20% over the four years of the agreement

Commit to provide an additional 326 subacute beds (or bed equivalent)

The framework underpins our planning to ensure that Victoria meets its commitments under these agreements.