clinical focus
REAPing the benefits
Post-hospital care intervention reduces
resident readmission.
Nicholas Cordato interviewed by Dallas Bastian
F
ewer nursing home residents are needing to return to
hospital after discharge under a program that involves
regular specialist follow-up.
The intervention, called Regular Early Assessment Post-
Discharge (REAP), was developed by a team from Sydney’s St
George Hospital, Calvary Health Care and UNSW’s Centre for
Healthy Brain Ageing (CHeBA).
REAP sees residents receive seven regular monthly conjoint
geriatrician and nurse practitioner nursing home visits for the first
six months following hospital admission.
A study into the intervention’s effectiveness found REAP was
associated with almost two-thirds fewer hospital readmissions,
and half as many emergency department visits, compared
with controls.
Professor Henry Brodaty, study co-author and co-director of
CHeBA, said that the total costs were also 50 per cent lower in the
REAP intervention group.
Lead author Dr Nicholas Cordato said re-hospitalisation
of residents is costly, frequent, potentially avoidable and
associated with poor survival and diminished quality of life.
Aged Care Insite spoke with Cordato, a senior lecturer at UNSW
and senior staff specialist at St George and Calvary hospitals, to
find out what makes the program a success and whether it should
be rolled out across Australia.
22 agedcareinsite.com.au
ACI: The project is tackling the issue of re-hospitalisation
and you said some cases are potentially avoidable, so setting
aside the fact that many older Australians are frail coming into
residential aged care, and with multiple comorbidities, why are
we seeing people heading back to hospital after discharge?
NC: Well, there are numerous factors that contribute to this
problem. The fact that these people are frail means they are more
susceptible to acute illness, and to adverse outcomes related to
their illness. Their vulnerability is heightened by their frequent
inability to articulate the symptoms, or their wishes, and this
means that treatment can often be delayed, and medical issues
aren’t prevented from evolving into something more serious.
Conversely, hospital admissions often occur for conditions which
really don’t respond to treatment very well, and the decision to
send residents into hospital sometimes goes against the wishes of
the resident and their family.
The failure to appreciate these kinds of issues can lead to
multiple re-presentations to hospital, and this can occur within
a short space of time. So many of these treatments can often be
given with equivalent effectiveness within nursing homes, and
this can therefore potentially avoid transfer to hospital, and the
hospital transfers can often be distressing and disorienting for
residents. But implementation of these effective treatments in
nursing homes, however, requires adequate levels of clinical input
into nursing homes, and these treatments actually also need to be
given in a timely manner.
Most medical input into nursing homes is provided by GPs, but
GPs are finding it increasingly challenging to provide this input
regularly into nursing home residents’ care.