Hospital in the home (HiTH) is a key demand management strategy for the NSW Government. The NSW Ministry of Health aimed to understand the nature and costs of patients receiving HiTH to support more informed decisions on expanding HiTH.
In an initial project HPA developed specifications for costing HiTH services. In a second project HPA developed data set specifications for HiTH services, identifying and defining data elements to support costing. In a third project, HPA developed relative value units (RVU) as part of the Ministry’s costing of HiTH services.
NSW Ministry of Health
Our approach
Both of the 2012 and 2017 projects involved interviewing HiTH service managers, clinicians, business managers and costing staff. The 2012 project was across 10 sites and the 2017 over 12 sites. Each project was followed by workshops with key stakeholders; the 2012 project with more than 80 stakeholders to refine the project recommendations and the 2017 workshop with HiTH clinicians to validate the candidate data set and discuss approaches for its collection.
For the 2018 project to develop the RVUs, the Ministry wanted to use its existing barcode scanning infrastructure to collect clinician time and other variables impacting resource use from the 10 HiTH services. We worked with a software developer on a secure user-friendly interface for clinicians to download, review and submit activity data to the study.
We conducted face-to-face consultations with clinicians to develop the collection protocol; testing the solution iteratively and its integration with existing workflows. Once the protocol was finalised, we conducted clinician training with each HiTH service involved in the study and provided support to site coordinators throughout the study. Data collection was carried out over a two-month period.
We used the scanned data and routinely collected admitted patient data to develop RVUs to allocate doctor, nurse and allied health clinician time, imprest pharmacy and high-cost consumables to HiTH patients.
Outcome
The 2012 project resulted in recommendations for costing HiTH services. The 2017 project produced a data set specification for additional data to supplement the routine admitted patient data to enable costing of HiTH services, as well as planning, monitoring safety and quality, and benchmarking between services. NSW Health used the RVUs from the 2018 project to cost HiTH services and compare with ward-based care.
Our vision
HPA aims to be a leading firm in specialist consulting services in the health care sector, offering qualitative and quantitative analysis and synthesis of evidence, providing expertise in statistics and data science, and contributing to well founded and practical policy advice. We aim to deliver the highest quality of services, helping our clients to achieve their objectives, while transferring our expertise and building their capabilities.
