Reconfiguring in-patient services for adults with mental health problems: changing the balance of care

Tucker, Susan; Hughes, Jane; Jolley, David; Buck, Deborah; Hargreaves, Claire; Challis, David

doi:10.1192/bjo.2018.60

Cited by 5 publications

(4 citation statements)

References 15 publications

(28 reference statements)

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“…In part the BoC approach [82][83][84] was used to design a care pathway for people with dementia and MCI across the prison estate (see Chapter 5). We held workshops with prison staff and health and social care professionals working in the community and prisons, together with carers of people living with dementia in the community.…”

Section: Summary Of Findingsmentioning

confidence: 99%

Dementia and mild cognitive impairment in prisoners aged over 50 years in England and Wales: a mixed-methods study

Forsyth

Heathcote

Senior

et al. 2020

Health Serv Deliv Res

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Background People aged ≥ 50 years constitute the fastest-growing group in the prison population of England and Wales. This population has complex health and social care needs. There is currently no national strategy to guide the development of the many-faceted services required for this vulnerable population; therefore, prisons are responding to the issue with a range of local initiatives that are untested and often susceptible to failure if they are not fully embedded in and securely funded as part of commissioned services. Objectives The objectives were to establish the prevalence of dementia and mild cognitive impairment in prisoners in England and Wales and their health and social care needs; validate the six-item cognitive impairment test for routine use in prisons to aid early and consistent identification of older prisoners with possible dementia or mild cognitive impairment; identify gaps in current service provision; understand the first-hand experiences of prisoners living with dementia and mild cognitive impairment; develop a care pathway for prisoners with dementia and mild cognitive impairment; develop dementia and mild cognitive impairment training packages for staff and prisoners; and produce health economic costings for the care pathway and training packages. Design This was a mixed-methods study. Setting The study setting was prisons in England and Wales. Participants Prisoners aged ≥ 50 years and multiagency staff working in prison discipline and health and social care services took part. Results Quantitative research estimated that the prevalence rate of suspected dementia and mild cognitive impairment in the prison population of England and Wales is 8%. This equates to 1090 individuals. Only two people (3%) in our sample had a relevant diagnosis in their health-care notes, suggesting current under-recognition of these conditions. The prevalence rate in prisons was approximately two times higher among individuals aged 60–69 years and four times higher among those aged ≥ 70 years than among those in the same age groups living in the community. The Montreal Cognitive Assessment screening test was found to be more effective than the six-item cognitive impairment test assessment in the older prisoner population. Qualitative research determined that staff and prisoners lacked training in knowledge and awareness of dementia and mild cognitive impairment, and this leads to problematic behaviour being viewed as a disciplinary issue rather than a health issue. Local initiatives to improve the lives of prisoners with dementia and mild cognitive impairment are often disadvantaged by not being part of commissioned services, making them difficult to sustain. Multidisciplinary working is hampered by agencies continuing to work in silos, with inadequate communication across professional boundaries. A step-by-step care pathway for prisoners with dementia and mild cognitive impairment was developed, and two tiers of training materials were produced for staff and prisoners. Limitations Our prevalence rate was based on the results of a standardised assessment tool, rather than on clinical diagnosis by a mental health professional, and therefore it may represent an overestimation. Furthermore, we were unable to distinguish subcategories of dementia. We were also unable to distinguish between a likely diagnosis of dementia and other conditions presenting with mild cognitive impairment, including learning disability, severe depression and hearing impairment. Questionnaires regarding current service provision were collected over an extended period of time, so they do not reflect a ‘snapshot’ of service provision at a particular point. Conclusions We hypothesise that implementing the step-by-step care pathway and the training resources developed in this study will improve the care of older prisoners with dementia and mild cognitive impairment. Future work The care pathway and training materials should be evaluated in situ. Alternatives to prison for those with dementia or mild cognitive impairment should be developed and evaluated. Funding This project was funded by the National Institute for Health Research (NIHR) Health Services and Delivery Research programme and will be published in full in Health Services and Delivery Research; Vol. 8, No. 27. See the NIHR Journals Library website for further project information.

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Section: Summary Of Findingsmentioning

confidence: 99%

Dementia and mild cognitive impairment in prisoners aged over 50 years in England and Wales: a mixed-methods study

Forsyth

Heathcote

Senior

et al. 2020

Health Serv Deliv Res

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“…They also lead to better outcomes (Chafe et al., 2010). Research in the United Kingdom has shown that it is possible to better distribute institutional care for older persons (Tucker et al., 2018). Using an approach called the “Balance of Care (BoC),” researchers have identified the extent to which resource allocation may be improved at the local level for specific populations (including aging adults).…”

Section: Conclusion and Discussionmentioning

confidence: 99%

From prediction to decision: Optimizing long‐term care placements among older delayed discharge patients

Chuang

Zargoush

Ghazalbash

et al. 2023

Production and Operations Management

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This study examines long-term care (LTC) discharge planning among older delayed discharge patients. While awaiting placements in alternate care such as LTC, these patients occupy hospital beds despite not requiring an intensive level of care. This study proposes a novel discharge decision model based on the Markov decision process (MDP) framework, which incorporates predictions regarding the patients' health trajectory and the associated hospital costs. Our machine learning (ML)-based predictive analytics allow for considering heterogeneous health transitions, hence personalized decision making, leading to valuable information for reducing hospital costs. We also develop data-driven cost functions using patient characteristics to estimate the personlevel costs associated with the decisions in the optimization model, that is, whether or not to discharge a patient to LTC. The data analyses and cost estimations are based on large historical data collected over 13 years in Ontario, Canada. To solve the resulting high-dimensional MDP models, we develop an index policy, where each patient's index value is calculated using their health complexity (comorbidity), sex, age, and acute length of stay in the hospital. Using extensive numerical experiments, we illustrate the superior performance of the proposed index policy against some benchmarking policies and demonstrate the significance of predictive information in optimizing discharge decisions. Our results also indicate that the value of predictive information increases with LTC bed availability and decreases with hospital capacity. We also demonstrate that with the anticipated exacerbating mismatch between supply and demand, targeted prediction-driven discharge policies, such as the proposed index policy, become even more critical. K E Y W O R D Sdelayed discharge, discharge planning, Markov decision process, predictive analytics, value of information 1

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“…The present study has highlighted variability in the form, content, and potential impact of different approaches to resource allocation. There is scope for further research to build upon this in addressing the extent to which these different approaches concur using case vignettes as in balance of care studies (Asthana, 2012;Challis & Hughes, 2002;Tucker et al, 2008Tucker et al, , 2018; the impact upon practitioners, including their time use (Challis et al, 1990;Jacobs et al, 2006Jacobs et al, , 2011von Abendorff et al, 1994;Weinberg et al, 2003) and practice; and the views of service users and staff on both the tools and the processes involved in their use.…”

Section: Implications For Policy Practice and Researchmentioning

confidence: 99%

Understanding Resource Allocation Processes in Social Care for Frail Older People: Lessons from a National Survey

Stewart¹,

Hughes²,

Challis³

et al. 2021

Journal of Long Term Care

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Context: Traditionally local authorities in England allocated resources in social care following a professional assessment of need and a costed care plan. With the introduction of personal budgets, resource allocation tools have been used to provide service users with an initial indicative budget for their care. This is promoted as being more transparent, equitable and giving people greater control over decisions about their care. Objective: This study examined the different approaches to resource allocation and the content of resource allocation tools used for social care in England. Methods: Information was obtained from local authorities about their resource allocation systems. An analytic framework was developed and applied to the tools to explore: who identified needs; whether informal and formal support were recorded; and whether 17 need indicators covering functional status, mental health, and health and wellbeing were present and in what detail. Findings: Ninety-one per cent of 152 authorities responded and 61 per cent of authorities' tools were analysed. Three approaches were identified: points-based self-assessment tools; standardised assessment data (FACE); and non-points-based/ready reckoner tools. Most authorities used a points-based selfassessment tool. All tools included the service user's views and a high proportion included a professional's view, while fewer covered the carer's view on need. Coverage and presence of detail for the 17 need indicators showed high variation and was least on points-based self-assessment tools. Limitations: The study is the first to examine a large sample of resource allocation tools and provides a valuable baseline for future work. However, non-points-based/ready reckoner tools were under-represented in the sample. Implications: Further research could build upon this study to examine key properties of the tools used such as reliability, validity, sensitivity and specificity; and explore their impact upon service users and staff in terms of time use, cost, utility and equity.

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Reconfiguring in-patient services for adults with mental health problems: changing the balance of care

Cited by 5 publications

References 15 publications

Dementia and mild cognitive impairment in prisoners aged over 50 years in England and Wales: a mixed-methods study

Dementia and mild cognitive impairment in prisoners aged over 50 years in England and Wales: a mixed-methods study

From prediction to decision: Optimizing long‐term care placements among older delayed discharge patients

Understanding Resource Allocation Processes in Social Care for Frail Older People: Lessons from a National Survey

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