Abstract
Introduction:The Australian Gold Coast Integrated Care programme trialled a model of care targeting those with chronic and complex conditions at highest risk of hospitalisation with the goal of producing the best patient outcomes at no additional cost to the healthcare system. This paper reports the economic findings of the trial.Methods:A pragmatic non-randomised controlled study assessed differences between patients enrolled in the programme (intervention group) and patients who received usual care (control group), in health service utilisation, including Medicare Benefits Schedule and Pharmaceutical Benefits Scheme claims, patient-reported outcome measures, including health-related quality of life, mortality risk, and cost.Results:A total of 1,549 intervention participants were enrolled and matched on the basis of patient level data to 3,042 controls. We found no difference in quality of life between groups, but a greater decrease in capability, social support and satisfaction with care scores and higher hospital service use for the intervention group, leading to a greater cost to the healthcare system of AUD$6,400 per person per year. In addition, the per person per year cost of being in the GCIC programme was AUD$8,700 equating to total healthcare expenditures of AUD$15,100 more for the intervention group than the control group.Conclusion:The GCIC programme did not show value for money, incurring additional costs to the health system and demonstrating no significant improvements in health-related quality of life. Because patient recruitment was gradual throughout the trial, we had only one year of complete data for analysis which may be too short a period to determine the true cost-consequences of the program.
Highlights
The Australian Gold Coast Integrated Care programme trialled a model of care targeting those with chronic and complex conditions at highest risk of hospitalisation with the goal of producing the best patient outcomes at no additional cost to the healthcare system
The need for better integration of care in Australia has been addressed in national and state initiatives aimed at linking sectors of the health care system, but to date, there have been no consistent approaches to linking primary health care with other health services [6, 8]
RECRUITMENT Of the 2,708 patients invited into the programme, 1,795 (66%) consented to the programme and 62% (n = 1,685) consented to participate in the evaluation (Figure 1)
Summary
The Australian Gold Coast Integrated Care programme trialled a model of care targeting those with chronic and complex conditions at highest risk of hospitalisation with the goal of producing the best patient outcomes at no additional cost to the healthcare system. The Australian Gold Coast Integrated Care (GCIC) programme began in 2014 as a four-year pilot, proof-of-concept study to examine integrated care as a solution to inequitable, fragmented, costly, and unsustainable health services; these are significant issues for Australia as well as for other countries, given population ageing and substantial growth of chronic diseases [1,2,3,4,5]. Fragmentation of services is the most significant impediment to managing chronic diseases in the Australian health care system, due to the complex interplay of funding and divided responsibilities between the federal, state/territory, and local governments for both private and public health services. Instead the trial introduced a ‘cross-system’ approach to link primary and secondary care
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