CIHI Survey: Alternative Level of Care in Canada: A Summary :: Longwoods.com - 1 views
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Canadian health system managers are increasingly concerned about the number of hospital in-patients who do not need acute care services
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These patients are widely known as "ALC patients" because they are awaiting an alternative level of care in a more appropriate setting.
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This article summarizes more detailed findings presented in the recent report by the Canadian Institute for Health Information (CIHI 2009), Waiting in Hospital: Alternate Level of Care in Canada.
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In 2007-2008, 5% of hospitalizations (N = 74,504) and 14% of hospital days (N = 1.7 million) involved ALC patients. The provincial range for ALC hospitalizations was 2-7% of all hospitalizations (Figure 1).
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LC patients were also more than twice as likely to have a comorbid condition as measured by the Charlson Comorbidity Index (Sundararajan et al. 2004). Dementia, as a main or comorbid diagnosis, accounted for almost one quarter of ALC hospitalizations and more than one third of ALC days.
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Patients with dementia as a main diagnosis had a median ALC length of stay of 23 days compared with 10 days for ALC patients overall.
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More than one quarter of ALC patients were discharged home. Seventeen (17%) percent of these patients were readmitted to hospital within 30 days.
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Of the 12% who died during their ALC hospitalization, 42% were receiving palliative care and 45% were awaiting admission to another facility.
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This issue of ALC is a sizeable challenge for hospitals and health system managers in Canada, with over 1.7 million hospital days used for ALC outside of Manitoba and Quebec in 2007-2008.
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ALC patients were older and had diagnostic, comorbidity and length-of-stay profiles that indicate complex follow-up care requirements.
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The reasons for provincial and facility variations in the number of ALC patients and days are not well understood.
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Patient Pathway: Transfers from Continuing Care to Acute Care. found that new long-term care admissions accounted for most of the ALC waits for long-term care beds