Developing care for a changing population: supporting patients with costly, complex needs

Nuffield Trust
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Discussion paper providing a review of the emerging evidence and practice in Europe, alongside 10 reflections for policy-makers as they consider how to reform health systems to meet the needs of patients with complex, chronic conditions. It draws on insights from a review of literature reviews describing interventions for managing patients with complex conditions. The initial search retrieved 123 reviews, of which nine met the inclusion criteria. The studies fell into three broad categories: studies on improving care for complex patients while in hospital, interventions designed to improve the transition for complex patients between hospital and other settings in order to reduce readmissions and interventions designed to improve the care of complex patients in primary care and community settings. The paper then offers ten reflections for policy makers in relation to identifying target populations, the essential building blocks of services to meet the needs of these populations, what needs to be done to ensure successful implementation of strategies, how success can be measured, and identifying gaps in information. It is suggested that in order to respond to complex needs, new models are likely to involve blending elements of both acute and chronic care models. The paper concludes that new models of care need to be based on a better understanding of what patients (and carers) can manage in terms of their own treatment, offer access to both medical and non-medical support, and should be based on patients' desired outcomes. It notes that policy makers should be realistic about the impact on acute hospital use, reduced costs and savings. (Edited publisher abstract)

Subject terms:
literature reviews, good practice, complex needs, intervention, health care, self care, costs, patients, long term conditions, integrated care;
Content type:
research review
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