Clinic-based HITH: Block-funded facilities and Medical Services 3 and below

Guideline number: QH-GDL-379-1

Effective date: 22 December 2023

Review date: 22 December 2026

Supersedes: Version 1

1. Purpose
2. Background
3. Related documents
4. Facility eligibility
5. Requirements for Hospital and Health Services (HHSs)
6. Patient eligibility
7. Patient acceptance
8. Quality and safety
9. Document approval
10. Version control

1. Purpose

This guideline provides recommendations regarding best practice for Clinic-Based Hospital in the Home (CBHITH) within block-funded facilities and Clinical Services Capability Framework Medical Services 3 and below.

The purpose of CBHITH is to increase patients’ access to and choice of health care services in rural and remote areas, through the modification of the current Hospital in the Home (HITH) guideline. CBHITH is the provision of traditional inpatient treatment in an outpatient clinical setting in a block funded environment and Clinical Services Capability Framework Medical Services 3 and below.

2. Background

Patients requiring inpatient care in rural and remote areas have traditionally only been able to access hospital level care within the hospital setting. Block funding is typically applied for small public hospitals where there is an absence of economies of scale. HITH, in the traditional home visiting sense, may not be a viable option for block funded facilities and Clinical Services Capability Framework Medical Services 3 and below due to limited staffing and the geographical location of patients.

3. Related documents

Standards, procedures and guidelines

Following are documents that support the implementation of this guideline:

• Hospital in the Home guideline (inclusive of HITH suggested key performance indicators (KPIs)/minimum data set)
• Hospital in the Home: During a pandemic guideline
• Hospital in the Home: Standards of care guideline (outlines standards that define the type and quality of care to be provided by Queensland public HITH services)
• Queensland Hospital Admitted Patient Data Collection (QHAPDC) Manual

4. Facility eligibility

Facilities eligible under the HITH principles to establish CBHITH, are those listed as block funded facilities in the Hospital and Health Services Funding and Purchasing Guidelines. This document defines facilities eligible for block funding under the National Efficient Cost (NEC) model as public hospitals that provide admitted patient services and whereby:

• the technical requirements for applying Activity Based Funding (ABF) are not able to be satisfied
• there is an absence of economies of scale that mean some services would not be financially viable under ABF.

The Independent Hospital Pricing Authority (IHPA) has also determined ‘low volume’ thresholds that form part of the block funding criteria. Under these thresholds, hospitals are eligible for block funding if they are:

• in a metropolitan area (defined as ‘major city’ in the Australian Statistical Geography Standard (ASGS) and they provide ≤1,800 acute inpatient National Weighted Activity Units (NWAUs) per annum, or
• in a rural area (defined as all remaining areas, including ‘inner regional’, ‘outer regional’, ‘remote’ and ‘very remote’ in the Australian Statistical Geography Standard) with less than 3,500 total NWAUs per annum.

5. Requirements for Hospital and Health Services (HHSs)

CBHITH must be appropriately staffed with dedicated governance and resources to ensure patient care is timely and safe. This includes that:

• the HHS has capacity (staff, equipment, physical space) to meet the patient’s requirements
• the workforce is able to provide 24-hour cover, including medical and nursing staff
• there is appropriate access to Pharmacist and Allied Health services
• health care and personal care workers are available as required
• there are dedicated clinical facilities for patients to attend and receive treatment
• there are efficient easy referral, discharge, and clinical handover processes
• defined localised pathways for patients on CBHITH are developed, to ensure CBHITH is not utilised as a substitution for existing post-acute care services
• interfaces with General Practitioners (GPs) and shared care models are implemented appropriately.

Compliance with this guideline is not mandatory, but sound reasoning must exist for departing from the recommended principles. Unless mentioned in this guideline, all other requirements under the Hospital in the Home guideline remain applicable.

6. Patient eligibility

The decision regarding CBHITH treatment is to be patient-focused, taking into consideration the psychological, physical, and environmental needs of the patient. Consideration must also be given to the following:

• patients must meet the admission requirement as stated in the relevant HHS admission policy
• patients should have access to attend clinic-based treatment and the ability to transport themselves
• patients/carers should be assessed as competent to identify a deterioration of their condition
• patients have capacity and willingness to comply with a documented treatment plan
• patients need to consent to transfer of care, this is to be documented and evidenced in the patient medical record
• patients’ cultural safety and social needs
• Medicare Benefits Schedule (MBS) eligibility—refer HITH guideline—exclusion criteria.

7. Patient acceptance

An authorised practitioner working within their recognised scope of practice must accept responsibility for the patient. The patient is then transferred to a virtual ward (i.e. HOMEXX) with the treating authorised practitioner recognised in Hospital Based Corporate Information System (HBCIS), as per the QHAPDC Manual.

8. Quality and safety

HHS quality and safety controls need to be established to determine clear standards and treatment plans. Consideration should be given to:

• establishment of reliable data sources for auditing of CBHITH, to ensure safe service is provided to patients
• proactive planning of hospital care
• proactive planning and coordination of relevant services
• effective and timely communication across all care providers
• ensuring CBHITH provides inpatient treatment consistent with the Clinical Services Capability Framework (CSCF) of the hospital setting.

9. Document approval

Document custodian
Director, Healthcare Improvement Unit, Clinical Excellence Queensland (CEQ)
Approval officer
Executive Director, Healthcare Improvement Unit, CEQ
Approval date: 22 December 2023

10. Version control