There have been multiple initiatives to address avoidable admission costs across the jurisdictions for more than 20 years. Most services, including social services and welfare, aged care, education, and employment, have split funding and administration across federal and state/territory systems.
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Medicare is the Australian federal government’s scheme to give universal public access to health care (funded by taxation-the Medicare levy) through (1) direct clinical service funding to general practitioners and specialists in all states and territories and (2) indirect financing, with the states and territories administering public hospital and most community services.
USING XLSTAT AFTER TRIAL PERIOD FREE
The Australia-wide universal free public health system has both federal and state/territorial governance. The intention-to-treat group included a MonashWatch active telehealth group consisting of those who used the telehealth service. We compared bed days for an intention-to-treat group versus a usual care control group for 30 months from the MonashWatch service commencement. This paper reports a pragmatic summative evaluation of the MonashWatch service. Health coaches triage calls and support participants to optimize their health journeys. A rule-based algorithm provides a real-time risk assessment of calls based on data entry and telecare guide opinion. Laypersons called telecare guides track risk and identify issues in biopsychosocial and environmental domains using frequent telephone calls and the Patient Journey Record System, which uses a client-server architecture with a browser-based user interface. The MonashWatch telehealth and coaching model used design principles to establish a collaborative patient-journey approach responding to broad social determinants beyond disease management and the boundaries of hospital, primary, home, and social care. An algorithm running on hospital data identifies patients at-risk of potentially preventable hospitalizations and informs participating hospitals who can use financing from anticipated admissions to address care needs better and earlier. HealthLinks: Chronic Care (HLCC) is a voluntary, funding-neutral reform that aims to support the Australian State of Victoria’s public health services in adopting outcome-based, rather than activity-based, funding. Rather than only paying for hospitalizations, projected admission funding is released in advance to hospitals to allow them to develop systems that will reduce preventable hospitalizations. A pragmatic study evaluated the impact of MonashWatch, a telehealth coaching capitated pilot service in Victoria, Australia, on bed days in the context of a statewide rollout of a new funding model. Potentially preventable hospitalizations or potentially avoidable admission costs are of significant interest, not only to governments and hospitals, but to individuals, their families, the community, and general practice. The net promoter score was 95% in the active telehealth group compared with typical hospital scores of 77%. The downward trend in improved bed days was significantly greater ( P<.001) in the intention-to-treat group (Sen slope –406) than in the usual care group (Sen slope –104). Both groups demonstrated regression-to-the-mean. The analysis of covariance demonstrated a reduction in bed days of 1.14 ( P<.001) in the intention-to-treat group compared with that in the usual care group, with 1236 bed days estimated savings. Age, MonashWatch effective days active, and treatment group independently predicted bed days.
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Admission frequency of intention-to-treat compared to that of the usual care group did not significantly improve ( P=.05), with a small number of very frequent admitters in the intention-to-treat group.