The second national audit of intermediate care

Abstract

Intermediate care services have developed internationally to expedite discharge from hospital and to provide an alternative to an emergency hospital admission. Inconsistencies in the evidence base and under-developed governance structures led to concerns about the care quality, outcomes and provision of intermediate care in the NHS. The National Audit of Intermediate Care was therefore established by an interdisciplinary group. The second national audit reported in 2013 and included crisis response teams, home-based and bed-based services in approximately a half of the NHS. The main findings were evidence of weak local strategic planning, considerable under-provision, delays in accessing the services and lack of mental health involvement in care. There was a very high level of positive patient experience reported across all types of intermediate care, though reported involvement with care decisions was less satisfactory.

Post-Acute Care as a Key Component in a Healthcare System for Older Adults

“…The American post-acute care case acceptance standards based on the post-acute care DRG systems led to significantly different groups of patients receiving care than under the intermediate care system of the UK. 17,18) Although numerous studies have confirmed that aging will increase medical expenditures, 19) National Beds Inquiry report of the UK in 2000 found that, despite the continuous increase in the country's older population starting in the 1980s, the number of acute hospital beds and days of patient hospitalization has in fact fallen steadily. The strict control of the number of days of hospitalization led to a very high percentage of older adults whose cognitive and physical function had not appropriately recovered being transferred to long-term care facilities.…”

A systematic review of the evidence on home care reablement services

“…46 We believe that our finding regarding reablement services (no completed RCTs or CCTs) is robust, due to the use of systematic review techniques. We accept that there are services calling themselves reablement services that do not fit the definition we used, such as those using health professionals rather than home care 47 and our findings do not apply to other variants of intermediate care such as health service based admission avoidance and early discharge services that have evidence, including evidence of some benefits such as reduced use of long term care and reduced hospital length of stay [48][49][50] .…”

Integrating Frailty Research into the Medical Specialties—Report from a U13 Conference

“…Because they defy the existing, disease‐specific organization of the healthcare system, frail individuals commonly are poorly served and therefore receive inadequate care. For example, a recent report by the National Health Service in the United Kingdom suggested that hospital care is so hazardous for older, frail adults that alternatives are needed …”