1. Home healthcare – an economic choice for the Health Service?
Ciaran O’Neill
School of Medicine and Dentistry
Queens University of Belfast

2. Acknowledgements Professor Nick Bosanquet, Imperial College London
Dr Robert Harte, Belfast Trust
Mr Nigel Jackson, NHSSB
Healthcare at Home Ltd.
NIHEG

3. Background Apparently competing forces:
Centralize in interests of quality and efficiency
Contain costs and make care more patient centred
Healthcare at home:
“..those services that provide active treatment by health care professionals in the patient’s home for a condition that would otherwise require acute hospital care, always for a limited period” (Shepperd & Iliffe 2005)

4. Paucity of existing studies
Heterogeneity: aims, conditions, models
Systematic review by Shepperd and Illife (2005)
22 studies
15 elderly medical patients
4 surgical patients
2 terminally ill patients
1 patients with mixture of medical/surgical conditions

5. No significant differences were found in mortality rates (12 studies) or readmission rates (10 studies) (Note though studies may have been underpowered)
Generally greater patient satisfaction expressed in respect of healthcare at home
“Despite increasing interest in the potential of hospital at home services as a cheaper alternative to inpatient care, this review provides insufficient objective evidence of economic benefit.” Shepperd and Illife (2005)
“Few differences in outcomes were detected. Thus the cost of hospital at home compared with hospital care becomes a primary concern.” (Shepperd et al 1998)

6. North Western Healthcare Study (1999)
924 episodes of home healthcare matched by age, sex, diagnoses and date of care with acute episodes
“Pure” substitution group significantly less expensive than in-hospital care $1,193 vs $3,567 for matched comparators
“Mixed” substitution group significantly more expensive $9,881 vs $4,450 for matched comparators
Overall no significant difference

7. Northern Board Study (2003)
164 patients treated 2001 to 2002.
Reimbursement compared with estimated in-hospital care and ambulance use
92 IV therapy, 21 medical, 51 oncology/haematology
Healthcare at home cost £105,069
Ambulance cost (saving) £197,637
Bed day/day procedure cost (saving) £282,536
Total net saving £375,104 or £2,287 per patient
High levels of patient satisfaction and consultant confidence
BUT a selection group, cost data limited, study duration limited

8. Aims
Compare the cost of home healthcare with care delivered in a hospital environment
Examine the outcomes associated with home healthcare in terms of patient satisfaction

9. Home healthcare in Northern Ireland
Full time qualified and experienced IV therapy and oncology specialist nursing staff
Patients with a range of conditions – MS, oncology, haematology, Crohn’s disease
Patients referred by hospital consultant following assessment of suitability
Home Healthcare Ltd.

10. Methods
Anonymised reimbursement data on 275 patients treated Jan 2006 – Dec 2006
Details of activity, reimbursement paid, age and gender
Number of visits per month estimated
NHSSB nursing and finance staff estimate the hospital care and the cost associated with delivering this had it been delivered in hospital
Costs examined for all care types and by vignette subgroup

12. Results
N = 274

16. Caveats
Figures are from one independent provider and may be un-representative
Costs do not include primary, community or informal care
Sample represents a selected group of clinically appropriate and willing patients
Average not marginal costs examined – the two could differ
Clinical practice may vary – e.g. in respect of chemo patients
Hospital costs elsewhere may not be as high

17. Conclusion
For this group of patients home healthcare costs are substantially lower than those estimated for delivery of care in a hospital environment
Patient satisfaction is high
This model of care has a role to play not just in saving money but in extending patient choice in NI and the UK