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Reducing hospital bed use by frail older people: results from a systematic review of the literature
- Authors:
- PHILP Ian, et al
- Journal article citation:
- International Journal of Integrated Care, 13(4), 2013, Online only
- Publisher:
- International Foundation for Integrated Care
Introduction: Numerous studies have been conducted in developed countries to evaluate the impact of interventions designed to reduce hospital admissions or length of stay (LOS) amongst frail older people. A systematic review of the recent international literature (2007-present) was carried out to help improve understanding about the impact of these interventions. Methods: The following databases were systematically searched: PubMed/Medline, PsycINFO, CINAHL, BioMed Central and Kings Fund library. Studies were limited to publications from the period 2007-present and a total of 514 studies were identified. Results: A total of 48 studies were included for full review consisting of 11 meta-analyses, 9 systematic reviews, 5 structured literature reviews, 8 randomised controlled trials and 15 other studies. Interventions were classified into those which aimed to prevent admission, interventions in hospital, and those which aimed to support early discharge. Conclusions: Reducing unnecessary use of acute hospital beds by older people requires an integrated approach across hospital and community settings. A stronger evidence base has emerged in recent years about a broad range of interventions which may be effective. Local agencies need to work together to implement these interventions to create a sustainable health care system for older people. (Edited publisher abstract)
Buffer management to solve bed-blocking in the Netherlands 2000–2010. Cooperation from an integrated care chain perspective as a key success factor for managing patient flows
- Authors:
- MUR-VEEMAN Ingrid, GOVERS Mark
- Journal article citation:
- International Journal of Integrated Care, 11(3), 2011, Online only
- Publisher:
- International Foundation for Integrated Care
In The Netherlands, attempts were made to tackle the problem of bed-blocking in hospitals by using an Intermediate Care Department (ICD) as a buffer for bed-blockers. However, research has shown that ICDs do not sufficiently solve the bed-blocking problem and that bed-blocking is often caused by a lack of buffer management. This paper explains the theory of Buffer management (BM), a tool that endeavours to balance patient flow in the hospital to nursing home chain of care. It then draws on the results of recent explorative research which indicated that the absence of BM is not the result of providers’ thinking that BM is unnecessary, unethical or impossible because of unpredictable patient flows. Instead, BM is hampered by a lack of cooperation between care providers.
Developing a capacity and demand model for out of hospital care: learning from supporting seven health and care systems
- Author:
- BOLTON John
- Publisher:
- Local Government Association
- Publication year:
- 2021
- Place of publication:
- London
This report shares the learning and developments that took place in seven health and care communities between July 2020 and June 2021 to improve their local arrangements on hospital discharge, referred to as Discharge to Assess or D2A with a focus on the needs of older people. The seven areas that took part in the review were: Leicestershire, Leicester City and Rutland (LLR); Stoke and North Staffordshire (SNS); Bristol, North Somerset, and South Gloucestershire (BNSSG); Sefton; North Tyneside; Surrey (The Royal Surrey County Hospital and Guildford and Waverly); and Dorset, Bournemouth, Christchurch and Poole (BCP). The aim was to help these systems understand how to optimise the arrangements for out of hospital care and how to establish joint arrangements between the NHS and the local authority. Phase one of the evaluation looked at if the right services were in place; phase two - counting the numbers of people on each pathway; phase three – the outcomes for older people. Key findings: the most difficult logistical challenge for all systems was bringing together the health and social care data to help understand the demand and pressures on the services that had been commissioned. Where data were available it demonstrated that the better-staffed community hospitals can get over 70 per cent of older people back to their own homes and where residential care beds were supported by therapists and nurses a similar percentage of older people returned home. Each system was concerned about the availability and supply of domiciliary care and in several places, workshops were organised solely to explore this. All the systems have now developed action plans which take them further on their journey. (Edited publisher abstract)
Does integrated governance lead to integrated patient care? Findings from the innovation forum
- Authors:
- BEECH Roger, et al
- Journal article citation:
- Health and Social Care in the Community, 21(6), 2013, pp.598-605.
- Publisher:
- Wiley
Good integration of services that aim to reduce avoidable acute hospital bed use by older people requires frontline staff to be aware of service options and access them in a timely manner. In three localities where closer inter-organisational integration was taking place, this research sought patients’ perceptions of the care received across and within organisational boundaries. Between February and July 2008, qualitative methods were used to map the care journeys of 18 patients (six from each site). Patient interviews (46) covered care received before, at the time of and following a health crisis. Additional interviews (66) were undertaken with carers and frontline staff. Grounded theory-based approaches showed examples of well-integrated care against a background of underuse of services for preventing health crises and a reliance on ‘traditional’ referral patterns and services at the time of a health crisis. There was scope to raise both practitioner and patient awareness of alternative care options and to expand the availability and visibility of care ‘closer to home’ services such as rapid response teams. Concerns voiced by patients centred on the adequacy of arrangements for organising ongoing care, while family members reported being excluded from discussions about care arrangements and the roles they were expected to play. The coordination of care was also affected by communication difficulties between practitioners (particularly across organisational boundaries) and a lack of compatible technologies to facilitate information sharing. Finally, closer organisational integration seemed to have limited impact on care at the patient/practitioner interface. To improve care experienced by patients, organisational integration needs to be coupled with vertical integration within organisations to ensure that strategic goals influence the actions of frontline staff. As they experience the complete care journey, feedback from patients can play an important role in the service redesign agenda. (Publisher abstract)
Reasons for redesigning care for older people
- Author:
- PHILP Ian
- Journal article citation:
- Health Service Journal, 29.11.12, 2012, pp.30-32.
- Publisher:
- Emap Healthcare
South Warwickshire Foundation Trust has transformed its acute and community services to meet the needs of older people. A review of evidence about interventions to improve productivity and outcomes in older people's health and care led the Trust to focus on four main principles: get in early; invest in alternatives to acute hospital care; provide acute care by old age specialists; and discharge to assess. The principles have been put into practice in a number of linked projects. These include: using a single assessment instrument. EASY-Care, to be used by the health, social care and the third sector; close partnership working with adult social care and primary care services to provide alternatives to hospital care; and expansion of old-age specialist care teams.
Motivation to take part in integrated care: an assessment of follow-up home visits to elderly persons
- Authors:
- HJELMA Ulf, HENDRIKSEN Carsten, HANSEN Kirsten
- Journal article citation:
- International Journal of Integrated Care, 11(3), 2011, Online only
- Publisher:
- International Foundation for Integrated Care
Follow-up home visits by general practitioner and district nurse (within a week after discharge from hospital) can reduce hospital readmissions and improve the overall wellbeing of older people following hospital discharge. However, they can be difficult to implement because of a number of organizational obstacles, including co-ordination between the organizations involved in the process. Using inter-organisational network theory, this study examines the motivation and rationale of local care providers to invest time and effort in cross-sectoral follow-up home visits in Copenhagen, Denmark. Two focus groups and seven in-depth interviews were carried out with hospital staff, general practitioners, and district nurses. Care providers were motivated to collaborate by a number of factors. The focus of collaboration needs to be clearly defined and agreed upon, there needs to be a high degree of equality between the professionals involved, and there has to be a will to co-operate based on a shared understanding of values and learning potentials. The study concludes that motivational factors need to be addressed in future collaborative programmes in order to fully exploit the potential health benefits.
The effects of integrated home care and discharge practice on functional ability and health-related quality of life: a cluster-randomised trial among home care patients
- Authors:
- HAMMAR Teija, PERALA Marja-Leena, RISSANEN Pekka
- Journal article citation:
- International Journal of Integrated Care, 7(3), 2007, Online only
- Publisher:
- International Foundation for Integrated Care
The aim of this study was to evaluate the effects of integrated home care and discharge practice on the functional ability (FA) and health-related quality of life (HRQoL) of home care patients. A cluster randomised trial (CRT) with 22 Finnish municipalities as the units of randomisation. At baseline the sample included 669 patients aged 65 years or over. Data consisted of interviews (at discharge, and at 3-week and 6-month follow-up), medical records and care registers. The intervention was a generic prototype of care/case management-practice. The aim of the intervention was to standardize practices and make written agreements between hospitals and home care administrations, and also within home care and to name a care/case manager pair for each home care patient. The main outcomes were HRQoL and also Activities of Daily Living (ADL). All analyses were based on intention-to-treat. At baseline over half of the patient population perceived their FA and HRQoL as poor. At the 6-month follow-up there were no improvements in FA or in EQ-5D scores, and no differences between groups. In energy, sleep, and pain the NHP improved significantly in both groups at the 3-week and at 6-month follow-up with no differences between groups. In the 3-week follow-up, physical mobility was higher in the trial group. Although the effects of the new practice did not improve the patients' FA and HRQoL, except for physical mobility at the 3-week follow-up, the workers thought that the intervention worked in practice. The intervention standardised practices and helped to integrate services.
Working with the NHS
- Author:
- HUDSON Bob
- Journal article citation:
- Research Matters, 15, April 2003, pp.63-70.
- Publisher:
- Community Care
The Audit Commission is pressing for a whole-systems approach to council-NHS working. Looks at a report from the Audit Commission on integrated services for older people, and reports on two other studies which highlight the difficulties in achieving a whole-systems approach.
Impact of ‘enhanced’ intermediate care integrating acute, primary and community care and the voluntary sector in Torbay and South Devon, UK
- Authors:
- ELSTON Julian, et al
- Journal article citation:
- International Journal of Integrated Care, 22(1), 2022, p.14. Online only
- Publisher:
- International Foundation for Integrated Care
Introduction: Intermediate care (IC) was redesigned to manage more complex, older patients in the community, avoid admissions and facilitate earlier hospital discharge. The service was ‘enhanced’ by employing GPs, pharmacists and the voluntary sector to be part of a daily interdisciplinary team meeting, working alongside social workers and community staff (the traditional model). Methods: A controlled before-and-after study, using mixed methods and a nested case study. Enhanced IC in one locality (Coastal) is compared with four other localities where IC was not enhanced until the following year (controls), using system-wide performance data (N = 4,048) together with ad hoc data collected on referral-type, staff inputs and patient experience (N = 72). Results: Coastal showed statistically significant increase in EIC referrals to 11.6% (95%CI: 10.8%–12.4%), with a growing proportion from GPs (2.9%, 95%CI: 2.5%–3.3%); more people being cared for at home (10.5%, 95%CI: 9.8%–11.2%), shorter episode lengths (9.0 days, CI 95%: 7.6–10.4 days) and lower bed-day rates in ≥70 year-olds (0.17, 95%CI: 0.179–0.161). The nested case study showed medical, pharmacist and voluntary sector input into cases, a more holistic, coordinated service focused on patient priorities and reduced acute hospital admissions (5.5%). Discussion and conclusion: Enhancing IC through greater acute, primary care and voluntary sector integration can lead to more complex, older patients being managed in the community, with modest impacts on service efficiency, system activity, and notional costs off-set by perceived benefits. (Edited publisher abstract)
An electronic referral system supporting integrated hospital discharge
- Authors:
- WILBERFORCE Mark, et al
- Journal article citation:
- Journal of Integrated Care, 25(2), 2017, pp.99-109.
- Publisher:
- Emerald
Purpose: The purpose of this paper is to evaluate the implementation and potential value of an electronic referral system to improve integrated discharge planning for hospitalised older adults with complex care needs. This new technology formed part of the “Common Assessment Framework for Adults” policy in England. Design/methodology/approach: Mixed methods were undertaken as part of a case study approach within an acute hospital in the North West of England. First, qualitative interviews were undertaken with practitioners to explore early experiences using the new technology. Second, routinely collected administrative data were analysed, comparing referrals made using the new technology and those made through the usual paper-based process. Findings: Qualitative interviews found that an electronic discharge system has, in principle, the potential to improve the efficiency and suitability of integrated care planning. However, the implementation proved fragile to decisions taken elsewhere in the local care system, meaning its scope was severely curtailed in practice. Several “socio-technical” issues were identified, including the loss of valuable face-to-face communication by replacing manual with electronic referrals. Research limitations/implications: The small number of patients referred during the implementation phase meant that patient outcomes could not be definitively judged. Research into the longer-term implications and value of electronic referral systems is needed. Originality/value: There is concern that attempts to integrate health and social care are stymied by incompatible systems for recording service user information. This research explores a novel attempt to share assessment information and improve support planning across health and social care boundaries. (Publisher abstract)