Losing the Postcode Lottery: An Observational Study Examining the Association Between Patient Address and Delayed Discharge in a Rehabilitation Centre
Abstract Background Quality and Fairness: A Health System for You published by the HSE in 2001 stated, as one of its core principles “Access to healthcare should be fair. The system must respond to people’s needs rather than have access dependent on geographic location or ability to pay.”1 Twenty ye...
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| Veröffentlicht in: | Age and ageing 2024-09, Vol.53 (Supplement_4) |
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| creator | Murphy, Robert Allan Ward, Andrea Larkin, Joanne McKeag, Avril O'Connor, Marie |
| description | Abstract
Background
Quality and Fairness: A Health System for You published by the HSE in 2001 stated, as one of its core principles “Access to healthcare should be fair. The system must respond to people’s needs rather than have access dependent on geographic location or ability to pay.”1 Twenty years on, experience at our rehab unit suggests that inequality exists in accessing care in the community for older persons based on their residential address. The aim of our study was to examine and quantify this inequity of access.
Methods
A retrospective study was designed. Using the local patient information management system, all discharges in 2023 were identified. Baseline demographics, admission and discharge date and residential address were recorded. Delayed discharges were defined as patients for whom their rehabilitation programme is complete as agreed at the multi-disciplinary team meeting. Delayed discharge data was obtained from medical social work department who input this data to the HSE weekly. Patients were assigned a community healthcare organisation (CHO) based on address. CHO ‘A’ included two CHOs with predominantly rural areas whilst CHO ‘B’ comprised of one predominantly urban CHO.
Results
167 patients were included. 24 discharges were delayed (14.4%). Median age was 84. Total bed days lost: 935 (mean 40.6, range 3 – 232). All nine CHOs were represented. Patients living in CHO A had increased likelihood of having discharge delayed (OR: 4.82, CI 2.86 – 8.13). Conversely, those living in CHO B were less likely to have had a discharge delayed (OR: 0.39, CI 0.15 – 0.96)
Conclusion
Our study demonstrates that health inequity does exist. Patients residing in rural communities are 4 times more likely to have their discharge delayed awaiting community supports compared to urban dwellers. Ending of the discrimination of patients based on their postcode and ensuring access based on need is the very essence of Sláintecare. |
| doi_str_mv | 10.1093/ageing/afae178.016 |
| format | Article |
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Background
Quality and Fairness: A Health System for You published by the HSE in 2001 stated, as one of its core principles “Access to healthcare should be fair. The system must respond to people’s needs rather than have access dependent on geographic location or ability to pay.”1 Twenty years on, experience at our rehab unit suggests that inequality exists in accessing care in the community for older persons based on their residential address. The aim of our study was to examine and quantify this inequity of access.
Methods
A retrospective study was designed. Using the local patient information management system, all discharges in 2023 were identified. Baseline demographics, admission and discharge date and residential address were recorded. Delayed discharges were defined as patients for whom their rehabilitation programme is complete as agreed at the multi-disciplinary team meeting. Delayed discharge data was obtained from medical social work department who input this data to the HSE weekly. Patients were assigned a community healthcare organisation (CHO) based on address. CHO ‘A’ included two CHOs with predominantly rural areas whilst CHO ‘B’ comprised of one predominantly urban CHO.
Results
167 patients were included. 24 discharges were delayed (14.4%). Median age was 84. Total bed days lost: 935 (mean 40.6, range 3 – 232). All nine CHOs were represented. Patients living in CHO A had increased likelihood of having discharge delayed (OR: 4.82, CI 2.86 – 8.13). Conversely, those living in CHO B were less likely to have had a discharge delayed (OR: 0.39, CI 0.15 – 0.96)
Conclusion
Our study demonstrates that health inequity does exist. Patients residing in rural communities are 4 times more likely to have their discharge delayed awaiting community supports compared to urban dwellers. Ending of the discrimination of patients based on their postcode and ensuring access based on need is the very essence of Sláintecare.</description><identifier>ISSN: 0002-0729</identifier><identifier>EISSN: 1468-2834</identifier><identifier>DOI: 10.1093/ageing/afae178.016</identifier><language>eng</language><publisher>Oxford: Oxford University Press</publisher><subject>Ability to pay ; Access ; Community ; Delayed ; Discharge ; Discrimination ; Health care ; Health care access ; Health disparities ; Health services ; Inequality ; Information management ; Medical social work ; Multidisciplinary teams ; Observational studies ; Older people ; Patient information ; Patients ; Rehabilitation ; Rural areas ; Rural communities ; Teamwork ; Treatment programs ; Urban areas</subject><ispartof>Age and ageing, 2024-09, Vol.53 (Supplement_4)</ispartof><rights>The Author(s) 2024. Published by Oxford University Press on behalf of the British Geriatrics Society. All rights reserved. For permissions, please email: journals.permissions@oup.com 2024</rights><rights>The Author(s) 2024. Published by Oxford University Press on behalf of the British Geriatrics Society. All rights reserved. For permissions, please email: journals.permissions@oup.com</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>314,776,780,1578,27903,27904,30978,33753</link.rule.ids></links><search><creatorcontrib>Murphy, Robert Allan</creatorcontrib><creatorcontrib>Ward, Andrea</creatorcontrib><creatorcontrib>Larkin, Joanne</creatorcontrib><creatorcontrib>McKeag, Avril</creatorcontrib><creatorcontrib>O'Connor, Marie</creatorcontrib><title>Losing the Postcode Lottery: An Observational Study Examining the Association Between Patient Address and Delayed Discharge in a Rehabilitation Centre</title><title>Age and ageing</title><description>Abstract
Background
Quality and Fairness: A Health System for You published by the HSE in 2001 stated, as one of its core principles “Access to healthcare should be fair. The system must respond to people’s needs rather than have access dependent on geographic location or ability to pay.”1 Twenty years on, experience at our rehab unit suggests that inequality exists in accessing care in the community for older persons based on their residential address. The aim of our study was to examine and quantify this inequity of access.
Methods
A retrospective study was designed. Using the local patient information management system, all discharges in 2023 were identified. Baseline demographics, admission and discharge date and residential address were recorded. Delayed discharges were defined as patients for whom their rehabilitation programme is complete as agreed at the multi-disciplinary team meeting. Delayed discharge data was obtained from medical social work department who input this data to the HSE weekly. Patients were assigned a community healthcare organisation (CHO) based on address. CHO ‘A’ included two CHOs with predominantly rural areas whilst CHO ‘B’ comprised of one predominantly urban CHO.
Results
167 patients were included. 24 discharges were delayed (14.4%). Median age was 84. Total bed days lost: 935 (mean 40.6, range 3 – 232). All nine CHOs were represented. Patients living in CHO A had increased likelihood of having discharge delayed (OR: 4.82, CI 2.86 – 8.13). Conversely, those living in CHO B were less likely to have had a discharge delayed (OR: 0.39, CI 0.15 – 0.96)
Conclusion
Our study demonstrates that health inequity does exist. Patients residing in rural communities are 4 times more likely to have their discharge delayed awaiting community supports compared to urban dwellers. Ending of the discrimination of patients based on their postcode and ensuring access based on need is the very essence of Sláintecare.</description><subject>Ability to pay</subject><subject>Access</subject><subject>Community</subject><subject>Delayed</subject><subject>Discharge</subject><subject>Discrimination</subject><subject>Health care</subject><subject>Health care access</subject><subject>Health disparities</subject><subject>Health services</subject><subject>Inequality</subject><subject>Information management</subject><subject>Medical social work</subject><subject>Multidisciplinary teams</subject><subject>Observational studies</subject><subject>Older people</subject><subject>Patient information</subject><subject>Patients</subject><subject>Rehabilitation</subject><subject>Rural areas</subject><subject>Rural communities</subject><subject>Teamwork</subject><subject>Treatment programs</subject><subject>Urban areas</subject><issn>0002-0729</issn><issn>1468-2834</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2024</creationdate><recordtype>article</recordtype><sourceid>7QJ</sourceid><sourceid>BHHNA</sourceid><recordid>eNqNkMlOwzAYhC0EEqXwApwscU7rJSu3UsoiRWrFco6c5HfrKo2L7QB5EZ4XQ8qd02ik-UaaQeiSkgklGZ-KNah2PRVSAE3SCaHxERrRME4DlvLwGI0IISwgCctO0Zm1W29pRNkIfeXaehK7DeCVtq7SNeBcOwemv8azFi9LC-ZdOKVb0eBn19U9XnyKnWr_sJm1ulK_CXwD7gOgxStvoXV4VtcGrMWirfEtNKIHr8pWG2HWgFWLBX6CjShVo9zQMPeYgXN0IkVj4eKgY_R6t3iZPwT58v5xPsuDys-OgwQyJtM6TCPCJOG8lILJSPI0oxwYTWgJSZ2xNOF1xDJSyZQLRksRQhgnLCR8jK6G3r3Rbx1YV2x1Z_xSW3BKeRiTkMU-xYZUZbS1BmSxN2onTF9QUvz8Xwz_F4f_C_-_h4IB0t3-P_lvRDCLpg</recordid><startdate>20240929</startdate><enddate>20240929</enddate><creator>Murphy, Robert Allan</creator><creator>Ward, Andrea</creator><creator>Larkin, Joanne</creator><creator>McKeag, Avril</creator><creator>O'Connor, Marie</creator><general>Oxford University Press</general><general>Oxford Publishing Limited (England)</general><scope>AAYXX</scope><scope>CITATION</scope><scope>7QJ</scope><scope>7T5</scope><scope>7TK</scope><scope>7U3</scope><scope>7U9</scope><scope>BHHNA</scope><scope>H94</scope><scope>K9.</scope><scope>NAPCQ</scope></search><sort><creationdate>20240929</creationdate><title>Losing the Postcode Lottery: An Observational Study Examining the Association Between Patient Address and Delayed Discharge in a Rehabilitation Centre</title><author>Murphy, Robert Allan ; Ward, Andrea ; Larkin, Joanne ; McKeag, Avril ; O'Connor, Marie</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c1096-7e92f8d48502f033bfa2f5f38913e2171be7d92873d5290cf83a21ba4e4672403</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2024</creationdate><topic>Ability to pay</topic><topic>Access</topic><topic>Community</topic><topic>Delayed</topic><topic>Discharge</topic><topic>Discrimination</topic><topic>Health care</topic><topic>Health care access</topic><topic>Health disparities</topic><topic>Health services</topic><topic>Inequality</topic><topic>Information management</topic><topic>Medical social work</topic><topic>Multidisciplinary teams</topic><topic>Observational studies</topic><topic>Older people</topic><topic>Patient information</topic><topic>Patients</topic><topic>Rehabilitation</topic><topic>Rural areas</topic><topic>Rural communities</topic><topic>Teamwork</topic><topic>Treatment programs</topic><topic>Urban areas</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Murphy, Robert Allan</creatorcontrib><creatorcontrib>Ward, Andrea</creatorcontrib><creatorcontrib>Larkin, Joanne</creatorcontrib><creatorcontrib>McKeag, Avril</creatorcontrib><creatorcontrib>O'Connor, Marie</creatorcontrib><collection>CrossRef</collection><collection>Applied Social Sciences Index & Abstracts (ASSIA)</collection><collection>Immunology Abstracts</collection><collection>Neurosciences Abstracts</collection><collection>Social Services Abstracts</collection><collection>Virology and AIDS Abstracts</collection><collection>Sociological Abstracts</collection><collection>AIDS and Cancer Research Abstracts</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Nursing & Allied Health Premium</collection><jtitle>Age and ageing</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Murphy, Robert Allan</au><au>Ward, Andrea</au><au>Larkin, Joanne</au><au>McKeag, Avril</au><au>O'Connor, Marie</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Losing the Postcode Lottery: An Observational Study Examining the Association Between Patient Address and Delayed Discharge in a Rehabilitation Centre</atitle><jtitle>Age and ageing</jtitle><date>2024-09-29</date><risdate>2024</risdate><volume>53</volume><issue>Supplement_4</issue><issn>0002-0729</issn><eissn>1468-2834</eissn><abstract>Abstract
Background
Quality and Fairness: A Health System for You published by the HSE in 2001 stated, as one of its core principles “Access to healthcare should be fair. The system must respond to people’s needs rather than have access dependent on geographic location or ability to pay.”1 Twenty years on, experience at our rehab unit suggests that inequality exists in accessing care in the community for older persons based on their residential address. The aim of our study was to examine and quantify this inequity of access.
Methods
A retrospective study was designed. Using the local patient information management system, all discharges in 2023 were identified. Baseline demographics, admission and discharge date and residential address were recorded. Delayed discharges were defined as patients for whom their rehabilitation programme is complete as agreed at the multi-disciplinary team meeting. Delayed discharge data was obtained from medical social work department who input this data to the HSE weekly. Patients were assigned a community healthcare organisation (CHO) based on address. CHO ‘A’ included two CHOs with predominantly rural areas whilst CHO ‘B’ comprised of one predominantly urban CHO.
Results
167 patients were included. 24 discharges were delayed (14.4%). Median age was 84. Total bed days lost: 935 (mean 40.6, range 3 – 232). All nine CHOs were represented. Patients living in CHO A had increased likelihood of having discharge delayed (OR: 4.82, CI 2.86 – 8.13). Conversely, those living in CHO B were less likely to have had a discharge delayed (OR: 0.39, CI 0.15 – 0.96)
Conclusion
Our study demonstrates that health inequity does exist. Patients residing in rural communities are 4 times more likely to have their discharge delayed awaiting community supports compared to urban dwellers. Ending of the discrimination of patients based on their postcode and ensuring access based on need is the very essence of Sláintecare.</abstract><cop>Oxford</cop><pub>Oxford University Press</pub><doi>10.1093/ageing/afae178.016</doi></addata></record> |
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| source | Sociological Abstracts; Applied Social Sciences Index & Abstracts (ASSIA); Oxford University Press Journals All Titles (1996-Current) |
| subjects | Ability to pay Access Community Delayed Discharge Discrimination Health care Health care access Health disparities Health services Inequality Information management Medical social work Multidisciplinary teams Observational studies Older people Patient information Patients Rehabilitation Rural areas Rural communities Teamwork Treatment programs Urban areas |
| title | Losing the Postcode Lottery: An Observational Study Examining the Association Between Patient Address and Delayed Discharge in a Rehabilitation Centre |
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