Introduction
The Community Speech Therapy (CST) Service was started in 2001 in HKWC. The service provides outreach swallowing management by HA Speech Therapist (ST) to patients living in residential care home for the elderly (RCHEs) in cluster. Currently, 0.9 FTE ST is allocated in HKWC and provides services to 57 RCHEs. The allocated manpower is inadequate for the huge population in RCHEs and limits the quantity and quality of service delivery. In 2012, 3 RCHEs under The Hong Kong Society for the Aged (SAGE) in HKWC started to provide out-sourced private ST service by their funding. In 2013, 1 FTE ST was recruited by the institution. The scope of institution ST service overlapped with that of HA outreach ST. The swallowing aspects of the elderly were unavoidably managed by STs from two parties. It was foreseeable that frontline staffs of RCHEs would be confused when there were discrepancies on swallowing management. Meetings between HA ST, Community Care Service Team (CCST) and the management of SAGE were held in 2013. The following common goals were agreed: - Better utilization of public and private resources (Public Private Partnership) - Better communication of STs from both parties - Ensure the continuity of swallowing management from HA to institution There were consensuses on several areas: - The elderly would be managed by both HA ST and Institution ST together. - Information flow of patients swallowing aspect between both parties was guaranteed. - Logistic of overall workflow and referrals criteria were agreed.
Objectives
This pilot study aims to evaluate the treatment effectiveness of the new co-operated ST service delivery model to RCHEs in HKWC, where the swallowing management was provided jointly by HA outreach ST and RCHEs institution ST under the PPP framework.
Methodology
- Study design: Retrospective cohort study. - Participants: Patients aged 65 years or above, referred to HA CST service and living in the 3 RCHEs under SAGE. - Sampling period: July 01, 2010 – June 31, 2011 with HA CST service only, and July 01, 2016 – June 31, 2017 with PPP ST service. - Data source: Retrospectively collected from discharge summary on HA electronic patient record (ePR). - Descriptive data: Number of new attendance, number of follow-up attendance, average waiting time, and number of visit. - Primary outcome: Acute hospital admission rate with medical diagnosis of pneumonia within 3 and 12 months of the first HA CST appointment in RCHEs. - Statistical analysis: Effect measures by relative risk, absolute risk reduction, number needed to treat, 95% confidence interval whenever appropriate.
Results & Outcome
Descriptive data: Number of new attendance: 75 in period with HA CST service only, 104 in PPP ST service period Number of follow-up attendance: 88 in period with HA CST service only, 73 in PPP ST service period Average waiting time: 43.5 days in period with HA CST service only, 23.9 days in PPP ST service period Number of visit by CST: 21 visits in period with HA CST service only, 29 visits in PPP ST service period Primary outcome: Acute hospital admission rate with medical diagnosis of pneumonia within 3 months: - Relative risk = 0.618, 95% CI [0.391, 0.977] - Absolute risk reduction = 14.3% - Number needed to treat = 7.01 Acute hospital admission rate with medical diagnosis of pneumonia within 12 months: - Relative risk = 0.714, 95% CI [0.536, 0.951] - Absolute risk reduction = 18.6% - Number needed to treat = 5.36 Interpretation: - Statistically significant reduced risk of hospitalization due to pneumonia post 3-month and 12-month after first assessment for PPP ST service - Treating every 7.01 and 5.36 patients under PPP ST service would respectively prevent one adverse outcome of hospitalization due to pneumonia within 3 months and 12 months of first assessment
Co-location with:
