Reducing emergency department presentations among chronically ill patients in Western Sydney : a key role for coordinated primary care

Coordination of health services is thought to improve health outcomes for patients with chronic and complex illness; however, there is limited quantitative evidence for the effectiveness of coordinated care programs. HealthOne Mount Druitt (HOMD) is a coordinated care program operating in a disadvantaged area of Western Sydney, Australia. It operates as a combination 'virtual' and 'hub and spoke' model, with care coordination provided by liaison nurses. We aimed to determine whether there were changes in the number of emergency department (ED) presentations, length of stay, and community health referrals in the 12 months following enrolment in HOMD, compared to the 12 months prior. A quantitative survey was also conducted to determine the perspectives of service providers on key aspects of HOMD. Enrolment in HOMD was followed by reductions in both the number of ED presentations and the amount of time spent by patients in the ED. Community health referrals were increased, and the pattern of referral to different types of community health services was altered. This study provides quantitative evidence that a coordinated care intervention improves patient health outcomes.