Hospital avoidance: an integrated community system to reduce acute hospital demand
Resource type
Authors/contributors
- McGeoch, Graham (Author)
- Shand, Brett (Author)
- Gullery, Carolyn (Author)
- Hamilton, Greg (Author)
- Reid, Matthew (Author)
Title
Hospital avoidance: an integrated community system to reduce acute hospital demand
Abstract
Background:Growth in emergency department (ED) attendance and acute medical admissions has been managed to very low rates for 18 years in Canterbury, New Zealand, using a combination of community and hospital avoidance strategies. This paper describes the specific strategies that supported management of acutely unwell patients in the community as part of a programme to integrate health services.Intervention:Community-based acute care was established by a culture of close collaboration and trust between all sectors of the health system, with general practice closely involved in the design and management of the services, and support provided by hospital specialists, coordination and diagnostic units, and competent informatics. Introduction of the community-based services was aided by a clinical guidance website and an education programme for general practice teams and allied health professionals.Outcomes:Attendance at EDs and acute medical admission rates have been held at low growth and, in some cases, shorter lengths of hospital stay. This trend was especially evident in elderly patients and those with ambulatory care sensitive or chronic disorders.Conclusions:A system of community-based care and education has resulted in sustained gains for the Canterbury health system and freed-up hospital resources. This outcome has engendered a sense of empowerment for general practice teams and their patients.
Publication
Primary Health Care Research & Development
Date
29 Oct 2019
Volume
20
Accessed
11/27/19, 8:21 PM
ISSN
1463-4236, 1477-1128
Short Title
Hospital avoidance
Language
en
Library Catalog
Cambridge Core
Notes
Study topic
Evaluation of Canterbury’s Acute Demand Management Service (ADMS) as a system-wide approach to reduce emergency department (ED) attendances and acute hospital admissions through integrated community-based care.
Study type
Descriptive case study with longitudinal service data (2000–2019).
Key findings
- Results showed a flattening of acute medical admission rates per 1,000 population, with 30% fewer acute medical hospital bed days used in 2017 compared to the national average.
- Between 2000 and 2018, Canterbury’s ADMS supported over 34,000 patients annually, contributing to a sustained reduction in ED attendances and acute medical admissions, particularly among patients aged 65+.
- The Canterbury Health System achieved a sustained reduction in acute medical admissions per capita, despite a growing and aging population, through a focus on integration and primary care enablement.
- HealthPathways was a critical enabler, providing GPs with agreed local guidance on management and referral for over 550 clinical conditions, supporting safe and consistent decision-making in the community.
- Community-based services like the Acute Demand Management Service (ADMS), supported by HealthPathways, allowed GPs to treat patients at home who would otherwise require hospitalisation.
- The integrated model relied on a culture of trust, shared clinical leadership, flexible funding, and strong relationships across sectors, highlighting the importance of alignment beyond technology.
- Relevance to HealthPathways: This study demonstrates how HealthPathways can support systemic change by enabling community-based care and reducing hospital pressure through better coordination and guidance.
Citation
McGeoch, G., Shand, B., Gullery, C., Hamilton, G., & Reid, M. (2019). Hospital avoidance: an integrated community system to reduce acute hospital demand. Primary Health Care Research & Development, 20. https://doi.org/10.1017/S1463423619000756
Topic
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