Reducing Unplanned Hospital Admissions and Hospital Bed Days in the Over 65 Age Group: Results from a Pilot Study

2008 ◽  
Vol 16 (1) ◽  
pp. 3-8 ◽  
Author(s):  
Patrick Keating ◽  
Angela Sealy ◽  
Linda Dempsey ◽  
Beverley Slater
Keyword(s):  
Social Care ◽  
Hospital Admissions ◽  
Ageing Population ◽  
Model Of Care ◽  
Emergency Admissions ◽  
Use Of Resources ◽  
Health And Social Care ◽  
Bed Days ◽  
Policy Direction ◽  
Unplanned Hospital Admissions

Against a background of an ageing population, rising emergency admissions and a policy direction moving towards providing care in the least intensive setting, this paper presents the dramatic results achieved in a 22‐week pilot of undivided health and social care replicating the Castlefields study and using Unique Care principles. In the context of practice‐based commissioning, where GP practices develop and commission services that represent the best model of care and use of resources for their patients, the potential for creating savings from this approach are discussed.

Reducing unplanned hospital admissions in Older people with high needs: a review of local practice in a small sample of primary care patients in an inner London borough.

2016 ◽  
Vol 6 (2) ◽  
pp. 108-118
Author(s):  
Harriet Selina Anne Sinclair ◽  
Alison Furey
Keyword(s):  
Primary Care ◽  
High Risk ◽  
Older People ◽  
Social Care ◽  
Hospital Admissions ◽  
Health Check ◽  
Care Needs ◽  
Health And Social Care ◽  
Risk Patients ◽  
Unplanned Hospital Admissions

Background: Older people with complex health and social care needs are a growing group of people with high use of NHS and social services. In particular, this group account for a large number of unplanned hospital admissions a year.Aims: To evaluate the evidence base for preventing unplanned hospital admissions in this group, to identify their characteristics and to undertake a focussed local review of their primary care management.Methods: A literature review, a review of the Southwark CCG data risk stratification tool and a review of high risk patients and their management at a Southwark GP practice.Results: High risk patients have multiple comorbidities and are frequent users of healthcare services. Although there was in general good involvement with social care services, there were certain areas that could be improved upon. For instance, the referral of frequent fallers to falls services and provision of an older person’s annual health check both offer opportunities for primary prevention.Conclusions: An older person’s annual health check would ensure holistic assessment of their health and social care needs and could then be acted upon to ensure that there is the required level of support in place, including a personalised anticipatory care plan and attention to key preventative measures such as falls prevention, exercise, smoking cessation, medicines optimisation and sensory impairment.

scholarly journals Comparison of the impact of two national health and social care integration programmes on emergency hospital admissions

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Marcello Morciano ◽  
Katherine Checkland ◽  
Mary Alison Durand ◽  
Matt Sutton ◽  
Nicholas Mays
Keyword(s):  
Social Care ◽  
Hospital Admissions ◽  
Emergency Admission ◽  
Emergency Admissions ◽  
Emergency Hospital ◽  
Emergency Hospital Admissions ◽  
Care Integration ◽  
Health And Social Care ◽  
The Impact ◽  
Expert Support

Abstract Background Policy-makers expect that integration of health and social care will improve user and carer experience and reduce avoidable hospital use. [We] evaluate the impact on emergency hospital admissions of two large nationally-initiated service integration programmes in England: the Pioneer (November 2013 to March 2018) and Vanguard (January 2015 to March 2018) programmes. The latter had far greater financial and expert support from central agencies. Methods Of the 206 Clinical Commissioning Groups (CCGs) in England, 51(25%) were involved in the Pioneer programme only, 22(11%) were involved in the Vanguard programme only and 13(6%) were involved in both programmes. We used quasi-experimental methods to compare monthly counts of emergency admissions between four groups of CCGs, before and after the introduction of the two programmes. Results CCGs involved in the programmes had higher monthly hospital emergency admission rates than non-participants prior to their introduction [7.9 (95% CI:7.8–8.1) versus 7.5 (CI: 7.4–7.6) per 1000 population]. From 2013 to 2018, there was a 12% (95% CI:9.5–13.6%) increase in emergency admissions in CCGs not involved in either programme while emergency admissions in CCGs in the Pioneer and Vanguard programmes increased by 6.4% (95% CI: 3.8–9.0%) and 8.8% (95% CI:4.5–13.1%), respectively. CCGs involved in both initiatives experienced a smaller increase of 3.5% (95% CI:-0.3–7.2%). The slowdown largely occurred in the final year of both programmes. Conclusions Health and social care integration programmes can mitigate but not prevent rises in emergency admissions over the longer-term. Greater financial and expert support from national agencies and involvement in multiple integration initiatives can have cumulative effects.

scholarly journals Refugee-like migrants have similar health needs to refugees: a New Zealand post-settlement cohort study

BJGP Open ◽  
2020 ◽  
Vol 4 (1) ◽  
pp. bjgpopen20X101013
Author(s):  
Jonathan Donald Kennedy ◽  
Serena Moran ◽  
Sue Garrett ◽  
James Stanley ◽  
Jenny Visser ◽  
...  
Keyword(s):  
Primary Care ◽  
Cohort Study ◽  
New Zealand ◽  
Primary Care Practice ◽  
Social Care ◽  
Hospital Admissions ◽  
Outpatient Service ◽  
Care Practice ◽  
Care Needs ◽  
Health And Social Care

BackgroundRefugees and asylum seekers have specific health and social care needs on arrival in a resettlement country. A third group — migrants with a refugee-like background (refugee-like migrants) — are less well defined or understood.AimUsing routinely collected data, this study compared demographics, interpreter need, and healthcare utilisation for cohorts of refugee-like migrants and refugees.Design & settingA retrospective cohort study was undertaken in Wellington, New Zealand.MethodData were obtained for refugee-like migrants and refugees accepted under the national quota system (quota refugees), who enrolled in a New Zealand primary care practice between 2011 and 2015. Data from the primary care practice and nationally held hospital and outpatient service databases, were analysed. Age and sex standardisation adjusted for possible differences in cohort demographic profiles.ResultsThe cohorts were similar in age, sex, deprivation, and interpreter need. Refugee-like migrants were found to have similar, but not identical, health and social care utilisation to quota refugees. Primary care nurse utilisation was higher for refugee-like migrants. Clinical entries in the primary care patient record were similar in rate for the cohorts. Emergency department utilisation and hospital admissions were similar. Hospital outpatient utilisation was lower for refugee-like migrants.ConclusionThis research suggests that health, social care, and other resettlement services should be aligned for refugee-like migrants and quota refugees. This would mean that countries accepting quota refugees should plan for health and social care needs of subsequent refugee-like migrant family migration. Further research should investigate matched larger-scale national health and immigration datasets, and qualitatively explore factors influencing health-seeking behaviour of refugee-like migrants.

New act, new opportunity for integration in Scotland

2015 ◽  
Vol 23 (1) ◽  
pp. 3-9 ◽  
Author(s):  
Alison Taylor
Keyword(s):  
Social Care ◽  
Institutional Care ◽  
Social Implications ◽  
Significant Shift ◽  
Ageing Population ◽  
Local Authorities ◽  
Content Type ◽  
Health And Social Care ◽  
Scottish Government ◽  
Health Boards

Purpose – In this paper, the Scottish Government's approach to improving outcomes for patients and service users by integrating health and social care planning and provision is described. The Scottish Parliament passed primary legislation in February 2014, which places requirements on Health Boards and Local Authorities to work together more closely than ever before. The paper aims to discuss these issues. Design/methodology/approach – This paper sets out the Scottish Government's legislative approach to integrating health and social care, based on previous experience of encouraging better partnership between health and social care working without legislative compulsion. Findings – The Scottish Government has concluded that legislation is required to create the integrated environment necessary for health and social care provision to meet the changing needs of Scotland's ageing population. Research limitations/implications – The paper is confined to experience in Scotland. Practical implications – Legislation is now complete, and implementation of the new arrangements is starting. Evaluation of their impact will be ongoing. Social implications – The new integrated arrangements in Scotland are intended to achieve a significant shift in the balance of care in favour of community-based support rather than institutional care in hospitals and care homes. Its social implications will be to support greater wellbeing, particularly for people with multimorbidities within communities. Originality/value – Scotland is taking a unique approach to integrating health and social care, focusing on legislative duties on Health Boards and Local Authorities to work together, rather than focusing on structural change alone. The scale of planned integration is also significant, with planning for, at least, all of adult social care and primary health care, and a proportion of acute hospital care, included in the new integrated arrangements.

scholarly journals Information sharing challenges in end-of-life care: a qualitative study of patient, family and professional perspectives on the potential of an Electronic Palliative Care Co-ordination System

BMJ Open ◽  
2020 ◽  
Vol 10 (10) ◽  
pp. e037483
Author(s):  
Holly Standing ◽  
Rebecca Patterson ◽  
Mark Lee ◽  
Sonia Michelle Dalkin ◽  
Monique Lhussier ◽  
...  
Keyword(s):  
Palliative Care ◽  
Qualitative Study ◽  
Information Sharing ◽  
End Of Life ◽  
End Of Life Care ◽  
Social Care ◽  
Hospital Admissions ◽  
Sufficient Information ◽  
Life Care ◽  
Health And Social Care

ObjectivesTo explore current challenges in interdisciplinary management of end-of-life care in the community and the potential of an Electronic Palliative Care Co-ordination System (EPaCCS) to facilitate the delivery of care that meets patient preferences.DesignQualitative study using interviews and focus groups.SettingHealth and Social Care Services in the North of England.Participants71 participants, 62 health and social care professionals, 9 patients and family members.ResultsFour key themes were identified: information sharing challenges; information sharing systems; perceived benefits of an EPaCCS and barriers to use and requirements for an EPaCCS. Challenges in sharing information were a source of frustration for health and social care professionals as well as patients, and were suggested to result in inappropriate hospital admissions. Current systems were perceived by participants to not work well—paper advance care planning (ACP) documentation was often unavailable or inaccessible, meaning it could not be used to inform decision-making at the point of care. Participants acknowledged the benefits of an EPaCCS to facilitate information sharing; however, they also raised concerns about confidentiality, and availability of the increased time and resources required to access and maintain such a system.ConclusionsEPaCCS offer a potential solution to information sharing challenges in end-of-life care. However, our findings suggest that there are issues in the initiation and documentation of end-of-life discussions that must be addressed through investment in training in order to ensure that there is sufficient information regarding ACP to populate the system. There is a need for further qualitative research evaluating use of an EPaCCS, which explores benefits and challenges, uptake and reasons for disparities in use to better understand the potential utility and implications of such systems.

scholarly journals Enablers and barriers to the implementation of socially assistive humanoid robots in health and social care: a systematic review

BMJ Open ◽  
2020 ◽  
Vol 10 (1) ◽  
pp. e033096 ◽  
Author(s):  
Irena Papadopoulos ◽  
Christina Koulouglioti ◽  
Runa Lazzarino ◽  
Sheila Ali
Keyword(s):  
Systematic Review ◽  
Older Adults ◽  
Social Care ◽  
Assessment Tool ◽  
Humanoid Robots ◽  
Current Evidence ◽  
Ageing Population ◽  
Technical Problems ◽  
Age Related ◽  
Health And Social Care

ObjectivesSocially assistive humanoid robots are considered a promising technology to tackle the challenges in health and social care posed by the growth of the ageing population. The purpose of our study was to explore the current evidence on barriers and enablers for the implementation of humanoid robots in health and social care.DesignSystematic review of studies entailing hands-on interactions with a humanoid robot.SettingFrom April 2018 to June 2018, databases were searched using a combination of the same search terms for articles published during the last decade. Data collection was conducted by using theRayyansoftware, a standardised predefined grid, and a risk of bias and a quality assessment tool.ParticipantsPost-experimental data were collected and analysed for a total of 420 participants. Participants comprised: older adults (n=307) aged ≥60 years, with no or some degree of age-related cognitive impairment, residing either in residential care facilities or at their home; care home staff (n=106); and informal caregivers (n=7).Primary outcomesIdentification of enablers and barriers to the implementation of socially assistive humanoid robots in health and social care, and consequent insights and impact. Future developments to inform further research.ResultsTwelve studies met the eligibility criteria and were included. None of the selected studies had an experimental design; hence overall quality was low, with high risks of biases. Several studies had no comparator, no baseline, small samples, and self-reported measures only. Within this limited evidence base, the enablers found were enjoyment, usability, personalisation and familiarisation. Barriers were related to technical problems, to the robots’ limited capabilities and the negative preconceptions towards the use of robots in healthcare. Factors which produced mixed results were the robot’s human-like attributes, previous experience with technology and views of formal and informal carers.ConclusionsThe available evidence related to implementation factors of socially assistive humanoid robots for older adults is limited, mainly focusing on aspects at individual level, and exploring acceptance of this technology. Investigation of elements linked to the environment, organisation, societal and cultural milieu, policy and legal framework is necessary.PROSPERO registration numberCRD42018092866.

scholarly journals Integrated care facilitation for older patients with complex health care needs reduces hospital demand

2007 ◽  
Vol 31 (3) ◽  
pp. 451 ◽  
Author(s):  
Stephen R Bird ◽  
William Kurowski ◽  
Gillian K Dickman ◽  
Ian Kronborg
Keyword(s):  
Health Care ◽  
Older People ◽  
Community Health ◽  
Hospital Admissions ◽  
Acute Hospital ◽  
Health Care Needs ◽  
Hospital Services ◽  
Model Of Care ◽  
Care Needs ◽  
Bed Days

Objective: The evaluation of a new model of care for older people with complex health care needs that aimed to reduce their use of acute hospital services. Method: Older people (over 55 years) with complex health care needs, who had made three or more presentations to a hospital emergency department (ED) in the previous 12 months, or who were identified by community health care agencies as being at risk of making frequent ED presentations, were recruited to the project. The participants were allocated a ?care facilitator? who provided assistance in identifying and accessing required health care services, as well as education in aspects of self management. Data for the patients who had been participants on the project for a minimum of 90 days (n = 231) were analysed for their use of acute hospital services (ED presentations, admissions and hospital bed-days) for the period 12-months pre-recruitment and postrecruitment. A similar analysis on the use of hospital services was conducted on the data of patients who were eligible and who had been offered participation, but who had declined (comparator group; n=85). Results: Post recruitment, the recruited patients displayed a 20.8% reduction in ED presentations, a 27.9% reduction in hospital admissions, and a 19.2% reduction in bed-days. By comparison, the patients who declined recruitment displayed a 5.2% increase in ED presentations, a 4.4 % reduction in hospital admissions, and a 15.3% increase in inpatient bed-days over a similar timeframe. Conclusion: A model of care that facilitates access to community health services and provides coordination between existing services reduces hospital demand.

How NHS Sutton Clinical Commissioning Group is working with care homes to improve the health and wellbeing of older residents

2015 ◽  
Vol 19 (2) ◽  
pp. 60-68
Author(s):  
Christine Harger
Keyword(s):  
Quality Of Care ◽  
Social Care ◽  
Care Homes ◽  
Ageing Population ◽  
Residential Homes ◽  
London Borough ◽  
Content Type ◽  
Health And Wellbeing ◽  
Health And Social Care

Purpose – The purpose of this paper is to describe how NHS Sutton Clinical Commissioning Group (Sutton CCG) is working with nursing homes, residential homes and other health and social care organisations in Sutton to improve the quality of provision for residents in nursing and residential homes “care homes”. Design/methodology/approach – The paper explains how Sutton CCG engaged with care homes initially to seek their views on whether they wanted support and what support they would value. It describes what arrangements Sutton CCG put in place for managers and staff in local care homes to provide support face-to-face. The paper outlines the key areas for improvement that Sutton CCG and the care homes are focusing on. It includes examples of work carried out jointly by the care homes and Sutton CCG to improve the quality of care for residents. It goes on to describe joint-working arrangements between the CCG, London Borough of Sutton and other health and social care organisations to ensure the overall quality of care homes in Sutton. Findings – The paper outlines feedback from care home managers and staff who were invited to share their views about what support they wanted from Sutton CCG. It includes early feedback from care homes about the support put in place and the areas where they have found it most useful. Practical implications – In the UK many older people live in care homes. Britain has an ageing population so the need for residential and nursing homes and the numbers of people living in care homes is only likely to increase. Our ageing population also places additional demands on the NHS, with residents in care homes often spending time in A&E and lengthy spells in hospital. This paper highlights how CCGs and other health and social care organisations can work with care homes to improve the health and wellbeing of older residents in care homes and reduce pressures on other health services. Originality/value – Sutton CCG has put in place new arrangements for working with care homes that aim to support carers to improve the lives of their older residents. The paper shares practical examples of support that the CCG has provided which has successfully improved care and decision making in care homes; early indications show this has reduced 999 calls and conveyances to hospital. Sutton CCG, London Borough of Sutton and other statutory organisations with responsibility for care homes in Sutton have also set up a joint intelligence group to gain an overall picture of the quality of the borough’s care homes.

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