Variation in healthcare services utilization and continuity of care in long-term care facilities: a cross-sectional study
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Date
2025
Authors
Schwabe, J.
Pulling, B.W.
Caughey, G.E.
Crotty, M.
Williams, H.
Kellie, A.
Roder, D.
Nixon, K.-L.
Harvey, G.
Sluggett, J.K.
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BMC Health Services Research, 2025; 25(1):1216-1-1216-18
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Johannes Schwabe, Brian W. Pulling, Gillian E. Caughey, Maria Crotty, Helena Williams, Andrew Kellie, David Roder, Krystal-Lee Nixon, Gillian Harvey, Janet K. Sluggett, Monica Cations, Tiffany K. Gill, Jyoti Khadka, Megan Corlis, Marilyn von Thien, Maria C. Inacio
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Abstract
Background Primary and specialist healthcare services are critical to ensuring high-quality care for people living in long-term residential aged care facilities (LTCFs). In Australia, these government-subsidized services include general practitioner attendances, health assessments, management plans, allied health services, pain medicine specialists, and mental healthcare, among others. Although the utilization of these services is known to be suboptimal, the extent and nature of variation in their use across LTCFs nationally remain unknown. Importantly, variation that is not attributable to resident needs or planned system design—termed unwarranted variation—has been shown to negatively impact health outcomes and warrants investigation. To address this gap, this population-based study aims to examine the national variation in primary and selected specialist healthcare services utilization and continuity of care in residential aged care facilities and characteristics of facility utilization outliers. Methods A national cross-sectional study of 173,275 non-Indigenous residents aged ≥65 years from 2,744 Australian facilities in 2019 was conducted. To evaluate continuity of care, the cohort was restricted to LTCF residents who entered care in 2019 and were alive for at least six months (N = 41,654 individuals in 2,680 LTCFs). Adjusted median service and continuity of care utilization per 100 residents were calculated. National variation in the rate of healthcare service utilization was quantified using inlier-ranges, categorized as minimal = 0, low < 20, moderate = 20–79, high = 80–99, and maximal = 100. Results Maximal variation for services with moderate utilization (median = 22.1–60.6/100 residents) was observed for after-hours attendances, urgent after-hours attendances, health assessments, management plans, podiatry, and optometric services. Continuity of care had low-to-moderate utilization (median = 13.4–26.6/100) and moderate-to-high variation (inlier-range = 68–95.5). Some services had high (median = 99.9/100, general attendances) or low (median < 8.2/100, specialist attendances) utilization and low-to-moderate variation. A small number of mostly high-utilization outliers were identified. Conclusions There is substantial variation in utilization of healthcare services and continuity of care amongst residential aged care facilities nationally. While some facilities deliver high levels of preventive and disease management healthcare services supporting residents to have high continuity of care, many facilities face challenges facilitating access to adequate healthcare for their residents.
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© The Author(s) 2025. Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article’s Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article’s Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/.