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A better START for older people reduces hospital stays

Research released this month shows that Waikato District Health Board’s Supported Transfer and Accelerated Rehabilitation Team (START) programme reduces the length of stay in hospital and the risk of readmission following discharge.

The research also showed the increased time the patients then spent recuperating at home under START care, reduced costs for the DHB over six months.

In the research 198 older people entered the trial and were randomised to either usual care or START.

All older people were followed up over six months.

In the hospital admission immediately prior to entering the trial, the older people in the usual care group spent on average 21.6 days in hospital versus 17.1 days in START.

START therefore achieved its objective of decreasing hospital length of stay.

In the six months following discharge from hospital, participants in the Usual Care group spent 20.6 days in hospital against 14.2 days in START; indicating that the START service had a highly effective role in reducing readmissions.

Total costs were also reduced; per participant costs in the Usual Care group were a mean NZ$16,943 versus NZ$10,836 in the START group (which included NZ$1,618 of START costs) in the six months following the initial hospital discharge.

The Health Research Council of New Zealand (HRC) through the Research Partnerships for New Zealand Delivery (RPNZHD) initiative funded Waikato DHB and the University of Auckland to conduct research on START to see whether it was achieving its intended objectives. The research results now come to the recently launched The Institute of Healthy Ageing.

The Institute of Healthy Ageing chair Barbara Garbutt said when Waikato DHB introduced START on a trial basis in Hamilton in October 2011 “we wanted to be sure results were evidence based.”

The programme rolled out in Thames/Hauraki and South Waikato from 1 February 2012 and is now in place throughout Waikato DHB.

START works with patients and their families in the patient’s own home to set rehabilitation goals and help patients to reach those goals.

Professor Matthew Parsons, Waikato DHB’s chair in gerontology nursing, a joint appointment between Auckland University and Waikato DHB, led the research.

“Having such dramatic research outcomes which proved START does what it sets out to do, was both reassuring and important for New Zealand as we strive to improve services for New Zealand’s older people,” said Prof Parsons.

“What makes these results so important is that we know from other research that the less time older people spend in hospital the better the rehabilitation outcomes are for them if they are well supported by something like the START programme in their own homes and community,” he said.

Older people receive rehabilitation at home for up to six weeks by a team of highly skilled health care assistants overseen by registered nurses with input from occupational therapists, physiotherapists and geriatricians.  Clients receive an individualised package of support and rehabilitation, which involves up to four visits a day, seven days a week.
START aims to enable early seamless discharge from hospital and to prevent readmission.  A GP can also refer directly to the service to prevent an admission.

ACC is currently working with The Institute of Healthy Ageing, Waikato DHB and the University of Auckland to explore how START can improve the experiences of older people following accidents and a similar trial started earlier this year.

Presentation at the March 2014 Disability Support Advisory Committee meeting

ENDS

General media enquiries
Mobile: 021 671 239
Email: news@waikatodhb.health.nz

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