A whole system study of intermediate care services for older people

Young, John; Robinson, Michael F.; Chell, Sue; Sanderson, Diana; Chaplin, Stephen; Burns, Eileen; Fear, Jon

doi:10.1093/ageing/afi179

Cited by 36 publications

(36 citation statements)

References 11 publications

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“…In an evaluation of a city-wide IC service within the UK, older patients (nϭ848, median age 85 years) presenting with falls, confusion, incontinence or immobility to an elderly medicine department were compared to historical controls. 43 Only 29% of these patients received any IC service (mainly HaH). Functional outcomes, institutionalisation rates and mortality were similar between groups.…”

Section: Discussionmentioning

confidence: 99%

Intermediate care for older people in the UK

Woodford

George

2010

Clinical Medicine

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-Intermediate care (IC) has been government policy for implementation in the UK for almost 10 years. It was hoped that it would help free up acute hospital resources. However, admission rates continue to rise and are rising fastest in those over the age of 75. Many different models of IC have been tried. Typically, outcomes are very similar to traditional hospital care and they tend to be met with high patient satisfaction. Yet there is no evidence that they reduce acute hospital use or that they are cost efficient. Maybe it is time to rethink our national strategy on this issue?

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Section: Discussionmentioning

confidence: 99%

Intermediate care for older people in the UK

Woodford

George

2010

Clinical Medicine

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“…However, this may not necessarily mean lower cost, particularly if undertaken within acute hospital environments. [9][10][11] There is often a high degree of substitution between these different forms of care, reflecting differences in clinical management of patients, in administrative processes including type-changing between different episodes of care and in the availability of appropriate treatment settings for each type of care, particularly in rural areas.…”

Section: Definition Of Subacute Carementioning

confidence: 99%

Projecting subacute inpatient activity in New South Wales

Gibbs¹,

Pearse²,

Jayasinha³

et al. 2009

Aust. Health Review

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We describe the development of a method for estimating and modelling future demand for suband non-acute inpatient activity across New South Wales, Australia to 2016. A time series linear regression equation was used, which is consistent with projection models found in the literature.Results of the modelling indicated an increase in rehabilitation, palliative care and maintenance episodes and bed-days. Projections for other categories of care are problematic due to smaller levels of activity and data quality issues. This project indicated a need for ongoing monitoring of type-changing by facilities and management of data quality. Local planners will need to consider a range of factors when considering the applicability activity projections at a local level, particularly THE ACUTE INPATIENT projection tool used by the NSW Health Department, aIM2005, incorporates subacute activity in its modelling, applying the same methodology for acute and subacute activity. 1 This methodology had not been validated for subacute care, which was seen as a key missing element within the planning process. Health service planners, particularly in rural regions, had requested assistance to develop a more consistent and systematic approach to sub-and non-acute care given the disparate nature of this activity.In late 2005, the New South Wales Health Department initiated a project requiring development of a methodology for estimating and modelling future demand for sub-and non-acute inpatient activity across NSW to 2016. 2 The objective of the project was to provide NSW with a well researched and credible projection methodology that can be used to model future demand (and potentially supply) of sub-and non-acute inpatient services. The methodology included consideration of factors that influence overall demand for these services and also the variation in demand across NSW, including: ■ Population demographic effects such as growth and ageing to 2016;

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“…While some studies have reported substantial challenges in the implementation process, [6] others have found significant decreases, not only in admission rates, costs and admission lengths, [7][8][9] but also in readmission rates. [10] A number of other studies, despite findings of increased costs, [11,12] report no significant impact on admission [1,2,13] and readmission rates. [14,15] The inconsistent findings may be due to the fact that the care of frail elderly citizens has multiple stakeholders, with different jurisdictions (e.g.…”

Section: Introductionmentioning

confidence: 97%

“…There is a growing body of evidence that suboptimal hospital care and treatment of frail elderly patients with complex medical issues are caused by short and compressed admissions [1,2] and by the loss of information in the transition from hospital to community care. [3] These problems are increasingly addressed through new forms of health care delivery, such as intermediate care interventions, traditionally targeting elderly people.…”

Section: Introductionmentioning

confidence: 99%

Inappropriate admissions or inadequate discharges of frail elderly: Competing program theories and implementation challenges in an intermediate care intervention

Nørgaard

Skjøt‐Arkil²,

Nissen³

et al. 2017

JNEP

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Intermediate care interventions are increasingly being implemented in the health services to avoid hospitalizing elderly frail patients with complex medical issues, often referred to as inappropriate or unwarranted admissions. This paper presents a theory-based stakeholder evaluation of an intervention involving hospitals, community care and general practitioners (GPs) in a Danish region with the overall objective to reduce the number of (inappropriate) hospital admissions for the frail elderly of 65 years or older. In a controlled study design elderly acutely ill patients were randomized to care and treatment either by a district nursing team or in an emergency department (ED) -both interventions with a 48-hour time limit. The district nursing teams were given access to various telemedicine solutions. In the programme theory analysis the stakeholders' normative theories, situation theories and causal theories were studied. Competing programme theories and barriers and facilitators were identified. Data were collected in interviews with stakeholders (managers, nurses, hospital physicians and GPs) and from the literature. The intervention included a regional hospital, four municipalities and 166 GPs servicing a mixed urban and rural region in Denmark. Four district nursing teams, eight GPs, three hospital physicians and two project managers were interviewed between January and March 2015. The stakeholder's programme theories were both concordant and competing; the GPs in particular were sceptical of the purported objective of reducing the number of inappropriate hospital admissions; they would rather see a reduction in the number of inappropriate hospital discharges. Our results indicate a compromised implementation process.

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A whole system study of intermediate care services for older people

Abstract: This city-wide IC service was associated with similar clinical outcomes but did not achieve its strategic objectives of reducing long-term care and hospital use.

Cited by 36 publications

References 11 publications

Intermediate care for older people in the UK

Intermediate care for older people in the UK

Projecting subacute inpatient activity in New South Wales

Inappropriate admissions or inadequate discharges of frail elderly: Competing program theories and implementation challenges in an intermediate care intervention

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