Combining data to improve health care for older Australians
Professor Maria Inacio is Director of the Registry of Senior Australians (ROSA) at the South Australian Health and Medical Research Institute. Maria helped set up ROSA in 2017. The registry combines health care and aged care data from around Australia. This combined data gives a whole picture of Australia’s ageing pathways for the first time.
‘I’m a technical person. I love the challenge of working with data to learn new things,’ Maria says. ‘I'm passionate about how we can use this information to improve care for older people.’
Evidence on aged care quality and safety
In the past, Maria used data from ROSA to give evidence to the Royal Commission into Aged Care Quality and Safety. ‘Our data influenced the Royal Commission’s recommendations. It helped drive reforms to aged care,’ Maria recalls.
‘For example, our data showed that when older people entered aged care facilities they received more psychotropic drugs. That evidence supported a recommendation to reduce the use of psychotropic drugs in aged care facilities.
‘Since the Royal Commission, there has been better quality and safety monitoring and a better data strategy to evaluate aged care quality,’ Maria says.
Finding the best health care for older Australians
Maria is now leading the first comprehensive nation-wide evaluation of older people’s use of primary health care and the effectiveness of this care in aged care settings.
Older people have more frailty, falls, chronic conditions and co-existing diseases. This means they have a high risk of emergency department presentations and hospital admissions.
These events often have poor health results including decline in function and quality of life. ‘Better primary health care could improve older people’s health and wellbeing,’ Maria says.
‘We want to find out how much primary health care older people get. We also want to know how care changes when people enter aged care facilities.’
Which health care services are best?
'93% of people in aged care facilities visit a GP about 25 times a year,’ Maria reports. ‘But we don’t know the results of these visits or if they meet older people’s needs.’
To answer that question, Maria is examining the relationship of primary health care services with:
- subsequent health encounters
- the length of stay at home or in residential care.
‘I want to be able to find the services or best combination of services that an older person can get to do the best they can. So, it's better for them, better for the system and less expensive,’ Maria explains.
The positive effect of preventive health care
In early results, Maria found there are 3 health care pathways for older people in aged care facilities. They have different mortality results:
- Older people who have preventive or multidisciplinary health care have the lowest mortality. This includes:
- health assessments
- chronic disease management plans or multidisciplinary care plans
- medication reviews
- allied health services
- People who see a GP a few times a year and receive minimal other services have mid-level mortality. Maria says this is likely due to them having less health issues.
- People who see a GP frequently, including urgent, after-hours consultations have the highest mortality. Maria says this may be because they have declining health, but it also may be because their health care is not well managed. She is trying to work through this question now.
‘It is reassuring to know that preventive health care can have a positive impact. We need to give people in aged care the best quality of life and the best experience they can have,’ Maria concludes.
How much preventive health care do older people get?
But Maria’s study shows that older people do not get as much preventive health care as they should.
‘They should have chronic disease management plans and a health assessment and medication review every year. They should get more mental health and allied health services. ‘This may be enough to keep older people healthy with a stable level of functional capacity and prevent cognitive decline.
‘But only about half of the people who are eligible for chronic disease management plans get them. The use of other services is even lower. This doesn't change much or gets worse once they enter aged care settings, which is unfortunate.’
Maria’s research indicates more coordinated and comprehensive primary health care could improve the health of older people. This could translate into lower risk of hospitalisations and other health events. ‘This approach could also make immense cost savings,’ Maria notes.
A community of stakeholders
Stakeholders who deliver primary health care to older people in aged care settings guide Maria’s research. ‘That community will also help put our findings into practice,’ Maria says.
Maria’s project ‘Using Big Data to Create Evidence-based Primary Health Care Service Delivery and Policy for the Australian Aged Care Sector—A Nationwide Study’ received a $1.435 million grant from the MRFF. In 2021 the MRFF contributed to supporting ROSA with a grant of $2 million.