The effectiveness and cost effectiveness of a hospital avoidance program in a residential aged care facility

Background Residential aged care facility residents experience high rates of hospital admissions which are stressful, costly and often preventable. Design Prospective pre-post cohort study and decision model analysis Intervention A decision-support tool was implemented to enable nursing staff to detect, refer and quickly respond to early signals of a deteriorating resident. Advanced clinical skills training, new diagnostic equipment and guided support from clinical lead nurses and nurse practitioners was provided to support nursing staff in the delivery of appropriate sub-acute care. Outcome measures Rate of hospital admissions; length of stay; incremental cost per QALY; net monetary benefit. Results The hospital avoidance program was associated with a 19% reduction in annual hospital admissions and a 31% reduction in the average length of stay. When modelled in a cohort of 1,000 residents the program resulted in a total of 1,606 fewer hospital bed days per annum. This contributed to a total cost saving of $2.6 million and 0.62 incremental QALYs gained per 1,000 residents. The program had a positive net monetary benefit and was considered cost-effective, even when the willingness to pay for health care gains was set to zero. A probabilistic sensitivity analysis estimated that there was an 86% probability that the program was cost-effective after taking the uncertainty of the model inputs into account. Conclusions This study provides compelling evidence for the effectiveness and cost-effectiveness of a RACF nurse led sub-acute care program in preventing unnecessary hospital admissions

Schools’ air quality monitoring for health and education: methods and protocols of the SAMHE initiative and project

Background: Children spend significant amounts of time at school, making the school environment a potentially important contributor to air quality exposure.  Aim: The SAMHE initiative has a dual aim: 1) to develop and test a bespoke citizen science framework for collecting environment and indoor air quality data in classrooms, alongside contextual data capable of enriching analysis, at an unprecedented scale; and, 2) to simultaneously use these methods to raise awareness among communities regarding their exposure to air pollution in the school environment.  Methodology: To achieve this dual aim, the SAMHE project was initiated to deploy more than 2 000 low-cost indoor air quality monitors in school classrooms. A Web App has been co-designed with schools to support collecting a large comprehensive dataset (including school buildings characteristics, operation, and behavioural patterns) and to enable students and teachers to interact with the data gathered in their school. Results and outlook: We present the design of the interface and visuals that have been co-designed with 20+ schools and tested with 120+ schools. Within one week of the SAMHE launch week, 537 schools had registered to join the project, and at the time of writing (just seven weeks later) this number had grown to around 800 schools. This highlights the potential for this novel initiative to provide a step-change in the way that indoor air quality datasets are gathered at a national and, potentially, international level while simultaneously enabling schools to better manage their indoor environment and empowering students and teachers to reduce their environmental health risks.</p