Why the study?
Outsourcing health-care services is increasingly common globally, but few published studies have evaluated the quality of care in health services using outsourcing.
Does outsourcing a Transition Care Program to private facilities affect length of stay, discharge destination, and falls in older people after a hospital stay?
Does outsourcing a Transition Care Program to private facilities affect length of stay, discharge destination, and falls in older people after a hospital stay?
Internally managed transition care programs may provide better quality of care, including shorter lengths of stay and fewer falls, compared to outsourced services.
Internal management was associated with better transition care quality than outsourcing; leaves open whether to limit outsourcing pending randomized trials.
BACKGROUND: Outsourcing health-care services has become popular globally, provided by both profit and non-for-profit organizations with varying degrees of quality. To date, few published studies have evaluated the quality of care in health services using outsourcing. OBJECTIVE: The purpose of this study was to determine if there were differences in quality of care (effectiveness, safety and patient experience) for a Transition Care Program designed to improve older people's independence and confidence after a hospital stay, when provided within a public health network compared to being outsourced to private facilities. METHODS: For clients discharged to a residential Transition Care Program operating across three sites from a large health service network (n = 1546), an audit of medical records was completed. Site 1 remained within the public health service (internally managed), whereas Sites 2 and 3 involved outsourcing to residential aged care facilities. The main outcome measures were discharge destination, length of stay and number of falls. Client demographics were analysed descriptively, and inferential statistics for continuous data and negative binomial regression for event data were used to examine differences between the sites. RESULTS: There were differences in quality of care between the internally and outsourced managed sites. One outsourced site discharged a smaller proportion to rehabilitation (P = 0.003) compared to the other two sites. There were differences in length of stay between the three sites. The length of stay was a mean of 4.8 days less at Site 1 (internally managed) (95% Confidence Interval (CI) 0.5 to 9.1) than Site 2 and 4.6 days less (95% CI 1.2 to 8.1) than Site 3. For those discharged to permanent residential care, the length of stay was 9.4 days less at the internal site than Site 2 (95% CI 3.5 to 15.2) and 7.0 days less than Site 3 (95% CI 1.9 to 12). Additionally, a lower rate of falls was recorded at Site 1 (internally managed) compared to Site 2 (outsourced) (incidence rate ratio = 0.44 (95% CI 0.32 to 0.60), P < 0.001). CONCLUSION: An internally managed Transition Care Program in a public health network was associated with better quality of care outcomes compared to outsourced services.
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Horne-Thompson et al. (2022) studied this question.
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