Economic evaluation of nurse led intermediate care versus standard care for post-acute medical patients: cost minimisation analysis of data from a randomised controlled trial

Walsh, Bronagh; Steiner, Andrea; Pickering, Ruth; Ward-Basu, Jilly

doi:10.1136/bmj.38397.633588.8f

Cited by 34 publications

(23 citation statements)

References 7 publications

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“…The goal was to create a department functioning as a new link between advanced care at a general hospital and community home care to optimise recovery before returning home after general hospital care [7]. There is little published knowledge about patient outcome and cost effectiveness when intermediate care [9] is provided at a community hospital instead of standard care at a general hospital [10-14]. …”

Section: Introductionmentioning

confidence: 99%

Intermediate care at a community hospital as an alternative to prolonged general hospital care for elderly patients: a randomised controlled trial

2007

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Abstract

Background

Demographic changes together with an increasing demand among older people for hospital beds and other health services make allocation of resources to the most efficient care level a vital issue. The aim of this trial was to study the efficacy of intermediate care at a community hospital compared to standard prolonged care at a general hospital.

Methods

In a randomised controlled trial 142 patients aged 60 or more admitted to a general hospital due to acute illness or exacerbation of a chronic disease 72 (intervention group) were randomised to intermediate care at a community hospital and 70 (general hospital group) to further general hospital care.

Results

In the intervention group 14 patients (19.4%) were readmitted for the same disease compared to 25 patients (35.7%) in the general hospital group (p = 0.03). After 26 weeks 18 (25.0%) patients in the intervention group were independent of community care compared to seven (10.0%) in the general hospital group (p = 0.02). There were an insignificant reduction in the number of deaths and an insignificant increase in the number of days with inward care in the intervention group. The number of patients admitted to long-term nursing homes from the intervention group was insignificantly higher than from the general hospital group.

Conclusion

Intermediate care at a community hospital significantly decreased the number of readmissions for the same disease to general hospital, and a significantly higher number of patients were independent of community care after 26 weeks of follow-up, without any increase in mortality and number of days in institutions.

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Section: Introductionmentioning

confidence: 99%

Intermediate care at a community hospital as an alternative to prolonged general hospital care for elderly patients: a randomised controlled trial

2007

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Abstract

Background

Methods

Results

Conclusion

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“…In addition, a financial analysis of this trial found significantly higher mean costs at six months in the nurse-led unit (mean excess £2,710 per patient, 95% CI £518 to £4,903). 31 A further similar trial randomised 175 patients (mean age 78.3 years) to a nurse-led unit or standard care. 32 Again, lengths of stay were longer in the intervention arm (mean excess stay 10.9 days, 95% CI 1.1-20.7 days), and costs were greater but this did not reach statistical significance (mean excess £1,044, 95% CI -£382 to £2,471).…”

Section: Nurse-led Unitsmentioning

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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“…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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Economic evaluation of nurse led intermediate care versus standard care for post-acute medical patients: cost minimisation analysis of data from a randomised controlled trial

Abstract: Objective To undertake an economic evaluation of nurse led intermediate care compared with standard hospital care for post-acute medical patients.

Cited by 34 publications

References 7 publications

Intermediate care at a community hospital as an alternative to prolonged general hospital care for elderly patients: a randomised controlled trial

Intermediate care at a community hospital as an alternative to prolonged general hospital care for elderly patients: a randomised controlled trial

Intermediate care for older people in the UK

Projecting subacute inpatient activity in New South Wales

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