Community hospitals and their services in the NHS: identifying transferable learning from international developments – scoping review, systematic review, country reports and case studies

Abstract

BackgroundThe notion of a community hospital in England is evolving from the traditional model of a local hospital staffed by general practitioners and nurses and serving mainly rural populations. Along with the diversification of models, there is a renewed policy interest in community hospitals and their potential to deliver integrated care. However, there is a need to better understand the role of different models of community hospitals within the wider health economy and an opportunity to learn from experiences of other countries to inform this potential.ObjectivesThis study sought to (1) define the nature and scope of service provision models that fit under the umbrella term ‘community hospital’ in the UK and other high-income countries, (2) analyse evidence of their effectiveness and efficiency, (3) explore the wider role and impact of community engagement in community hospitals, (4) understand how models in other countries operate and asses their role within the wider health-care system, and (5) identify the potential for community hospitals to perform an integrative role in the delivery of health and social care.MethodsA multimethod study including a scoping review of community hospital models, a linked systematic review of their effectiveness and efficiency, an analysis of experiences in Australia, Finland, Italy, Norway and Scotland, and case studies of four community hospitals in Finland, Italy and Scotland.ResultsThe evidence reviews found that community hospitals provide a diverse range of services, spanning primary, secondary and long-term care in geographical and health system contexts. They can offer an effective and efficient alternative to acute hospitals. Patient experience was frequently reported to be better at community hospitals, and the cost-effectiveness of some models was found to be similar to that of general hospitals, although evidence was limited. Evidence from other countries showed that community hospitals provide a wide spectrum of health services that lie on a continuum between serving a ‘geographic purpose’ and having a specific population focus, mainly older people. Structures continue to evolve as countries embark on major reforms to integrate health and social care. Case studies highlighted that it is important to consider local and national contexts when looking at how to transfer models across settings, how to overcome barriers to integration beyond location and how the community should be best represented.LimitationsThe use of a restricted definition may have excluded some relevant community hospital models, and the small number of countries and case studies included for comparison may limit the transferability of findings for England. Although this research provides detailed insights into community hospitals in five countries, it was not in its scope to include the perspective of patients in any depth.ConclusionsAt a time when emphasis is being placed on integrated and community-based care, community hospitals have the potential to assume a more strategic role in health-care delivery locally, providing care closer to people’s homes. There is a need for more research into the effectiveness and cost-effectiveness of community hospitals, the role of the community and optimal staff profile(s).FundingThe National Institute for Health Research Health Services and Delivery Research programme.

Analysis of the profile, characteristics, patient experience and community value of community hospitals: a multimethod study

“…Internationally, a similar picture has been observed, for example by Pitchforth et al 1 They echo British work in concluding that community hospitals defy 'the formulation of a single, overarching definition' (p. 47) (contains information licensed under the Non-Commercial Government Licence v2.0).…”

“…In this introductory chapter, we briefly describe the origins and development of community hospitals in England, before setting out the policy context and providing a brief summary of previous research about the role and function of community hospitals, patient experience and their community engagement and value. A formal review of the evidence was funded as part of the NIHR 12/177 call on research into community hospitals (see Pitchforth et al 1 ) and so was beyond the remit of this study.…”

“…In accordance with our protocol, as only one literature review had been funded across the three studies, we shared findings with the Nolte study team 98 and drew on its work to inform our typology development; a high level of consistency emerged. The Nolte study took as its working definition of community hospitals 'those (1) providing a range of services to a local community; (2) being led by community-based health professionals; and (3) providing inpatient beds', 1 (contains information licensed under the Non-Commercial Government Licence v2.0) but recognised that they provide a wide range of services which produced '. .…”

Conceptual modelling of the flow of frail elderly through acute-care hospitals

“…The first organisational unit selected to deal with the problem of frail patient management is the Intermediate Care Area (ICA). The ICA is usually located downstream from the acute area (which is in turn divided into a medical and surgical area) and is inspired by the community or country hospital model directed to deliver subacute care, seeking to reduce the number of inappropriate admissions to acute-care hospitals and to facilitate the discharge of patients from acute care (Pitchforth et al, 2017). Given the extent of definitions and operational experiences in the literature (Melis et al, 2004;Steiner, 2001), it is worth referring to the British Geriatric Society, which includes in intermediate care services that are limited in time (normally no longer than six weeks), involving crossprofessional working and targeted at people who would otherwise face unnecessarily prolonged hospital stays or inappropriate admission to acute inpatient, long-term residential, or continuing NHS inpatient care.…”

“…), bridging on two areas especially for frail, elderly and/or chronic patients. Evidence for the effectiveness of intermediate care and community hospitals is relatively scarce, and evidence for many services that fall under the broad rubric of intermediate care is lacking (Pitchforth et al, 2017;Steiner, 2001). In one study (Swanson and Hagen, 2016), the authors found evidence of reduced service utilisation, such as readmissions or community services use, among those treated in a community hospital compared with those treated in a general acute hospital.…”