scholarly journals Rapid evaluation for health and social care innovations: challenges for “quick wins” using interrupted time series

2019 ◽  
Vol 19 (1) ◽  
Author(s):  
Andrew McCarthy ◽  
Peter McMeekin ◽  
Shona Haining ◽  
Lesley Bainbridge ◽  
Claire Laing ◽  
...  
Keyword(s):  
Social Care ◽  
Interrupted Time Series ◽  
Models Of Care ◽  
Short Term ◽  
Data Set ◽  
Monthly Cost ◽  
Cost Increase ◽  
Term Model ◽  
Health And Social Care ◽  
Quasi Experimental

Abstract Background Rapid evaluation was at the heart of National Health Service England’s evaluation strategy of the new models of care vanguard programme. This was to facilitate the scale and spread of successful models of care throughout the health & social care system. The aim of this paper is to compare the findings of the two evaluations of the Enhanced health in Care Homes (EHCH) vanguard in Gateshead, one using a smaller data set for rapidity and one using a larger longitudinal data set and to investigate the implications of the use of rapid evaluations using interrupted time series (ITS) methods. Methods A quasi-experimental design study in the form of an ITS was used to evaluate the impact of the vanguard on secondary care use. Two different models are presented differing by timeframes only. The short-term model consisted of data for 11 months data pre and 20 months post vanguard. The long-term model consisted of data for 23 months pre and 34 months post vanguard. Results The cost consequences, including the cost of running the EHCH vanguard, were estimated using both a single tariff non-elective admissions methodology and a tariff per bed day methodology. The short-term model estimated a monthly cost increase of £73,408 using a single tariff methodology. When using a tariff per bed day, there was an estimated monthly cost increase of £14,315. The long-term model had, using a single tariff for non-elective admissions, an overall cost increase of £7576 per month. However, when using a tariff per bed-days, there was an estimated monthly cost reduction of £57,168. Conclusions Although it is acknowledged that there is often a need for rapid evaluations in order to identify “quick wins” and to expedite learning within health and social care systems, we conclude that this may not be appropriate for quasi-experimental designs estimating effect using ITS for complex interventions. Our analyses suggests that care must be taken when conducting and interpreting the results of short-term evaluations using ITS methods, as they may produce misleading results and may lead to a misallocation of resources.

scholarly journals Can changes in spending on health and social care explain the recent mortality trends in Scotland? A protocol for an observational study

BMJ Open ◽  
2020 ◽  
Vol 10 (7) ◽  
pp. e036025
Author(s):  
Christina Wraw ◽  
Jon Minton ◽  
Rory Mitchell ◽  
Grant M A Wyper ◽  
Clare Campbell ◽  
...  
Keyword(s):  
Primary Outcome ◽  
Social Care ◽  
Linear Regression Analysis ◽  
Mortality Rates ◽  
Secondary Outcome ◽  
Service Research ◽  
Mortality Trends ◽  
Data Set ◽  
Health And Social Care ◽  
The Absolute

IntroductionThere have been steady reductions in mortality rates in the majority of high-income countries, including Scotland, since 1945. However, reductions in mortality rates have slowed down since 2012–2014 in these nations; and have reversed in some cases. Deaths among those aged 55+ explain a large amount of these changing mortality trends in Scotland. Increased pressures on health and social care services have been suggested as one factor explaining these changes. This paper outlines a protocol for the approach to testing the extent to which health and social care pressures can explain recent mortality trends in Scotland. Although a slower rate of mortality improvements have affected people of all ages, certain ages have been more negatively affected than the others. The current analyses will be run by age-band to test if the service pressure-mortality link varies across age-group.Methods and analysisThis will be an observational ecological study based on the Scottish population. The exposures of interest will be the absolute (primary outcome) and percentage (secondary outcome) change in real terms per capita spending on social and healthcare services between 2011 and 2017. The outcome of interest will be the absolute (primary outcome) and percentage (secondary outcome) change in age-standardised mortality rate between 2012 and 2018 for men and women separately. The units of analysis will be the 32 local authorities and the 14 territorial health boards. The analyses will be run for both all age-groups combined and for the following age bands: <1, 1–15, 16–44, 45–64, 65–74, 75–84 and 85+.A series of descriptive analyses will summarise the distribution of health and social care expenditure and mortality trends between 2011 and 2018. Linear regression analysis will be used to investigate the direct association between health care spending and mortality rates.Ethics and disseminationThe data used in this study will be publicly available and aggregated and will not be individually identifiable; therefore, ethical committee approval is not needed. This work will not result in the creation of a new data set. On completion, the study will be stored within the National Health Service research governance system. All of the results will be published once they have been shared with partner agencies.

scholarly journals Association between the 2012 Health and Social Care Act and specialist visits and hospitalisations in England: A controlled interrupted time series analysis

PLoS Medicine ◽  
2017 ◽  
Vol 14 (11) ◽  
pp. e1002427 ◽  
Author(s):  
James A. Lopez Bernal ◽  
Christine Y. Lu ◽  
Antonio Gasparrini ◽  
Steven Cummins ◽  
J. Frank Wharham ◽  
...  
Keyword(s):  
Time Series ◽  
Time Series Analysis ◽  
Social Care ◽  
Interrupted Time Series ◽  
Interrupted Time Series Analysis ◽  
Series Analysis ◽  
Health And Social Care

scholarly journals Indigenous model of care to health and social care workforce planning

2018 ◽  
Vol 32 (1) ◽  
pp. 32-39
Author(s):  
Eileen Pepler ◽  
Rebecca C. Martell
Keyword(s):  
Population Health ◽  
Design Thinking ◽  
Social Care ◽  
Workforce Planning ◽  
Models Of Care ◽  
Scenario Planning ◽  
Health Delivery ◽  
Health And Wellbeing ◽  
Health And Social Care ◽  
Health Simulation

Indigenous people have always had the end in mind—a long range vision for the health and wellbeing of their families and communities. Creating Indigenous solutions-oriented approaches to strategic health and social care workforce planning is an essential component to the realization of self-determination and empowerment, accessible health services, community participation, and flexible approaches to care. This article suggests using an Indigenous “models of care” population health approach to health and social care workforce planning that takes a critical thinking, systems thinking, and design thinking approach using digital tools (eg, scenario planning and population health simulation). It also proposes to increase the number of Indigenous professionals through Indigenous partnership initiatives with professional groups and academic institutions. This article is written to encourage discussion on the use of a whole system approach to developing Indigenous models of health delivery and to inform strategic services and workforce planning.

scholarly journals Interrupted time series analyses on the effect on integrated care among the older population

2019 ◽  
Vol 29 (Supplement_4) ◽  
Author(s):  
J Agerholm
Keyword(s):  
Time Series ◽  
Integrated Care ◽  
Standard Care ◽  
Social Care ◽  
Interrupted Time Series ◽  
Income Group ◽  
Emergency Department Visits ◽  
Stockholm County ◽  
Health And Social Care ◽  
Care System

Abstract Background Current health and social care systems in most European countries, are highly fragmented into specialist services, and poorly designed to provide health and social care for patients with multiple health problems and social needs. As some groups of patients might have greater difficulties navigating in a fragmented and divided system than others, current system also risks increasing inequalities in access and use of health and social care services. The aim of this study is to investigate if a comprehensive integrated care system perform better than ‘standard care’ in regards to emergency department visits, hospitalization for ambulatory care sensitive conditions (ACSC), costs and re-admissions as well as increase equity in health care among older people. Methods This study is an intervention study based on a comparative interrupted time series design comparing data from Norrtälje, where an integrated care system was implemented in 2006, with other areas of Stockholm county with a standard care system. The time series consists of register data from 2000-2015, obtained from the Stockholm County Council’s administrative database of healthcare utilization and population data on socio-demographic characteristics from national registers. Preliminary results The preliminary results based on data from 2000-2011 suggest that the introduction of an integrated care system in Norrtälje did not affect the rate of hospitalization for ACSC, costs or rates of emergency department visits. When stratifying on income group we saw that the lowest income group did improve in some of the outcomes. Conclusions The integrated care system in Norrtälje seems to have no significant effect on the outcome measures included. Whether socioeconomic inequity was affected is still to be investigated further. Key messages In this study we used interrupted time series to investigate organisational changes in the health care sector. Introducing integrated care in Norrtälje seems to have little effect on register based outcome measures.

scholarly journals Roadmap layers and processes: resilient and sustainable care facilities

2019 ◽  
Vol 26 (9) ◽  
pp. 1986-2007
Author(s):  
Efthimia Pantzartzis ◽  
Andrew Price ◽  
Francis Edum Fotwe
Keyword(s):  
Asset Management ◽  
Social Care ◽  
Models Of Care ◽  
Decision Makers ◽  
Content Type ◽  
Health And Social Care ◽  
Care Facilities ◽  
Key Issues ◽  
Response To Change ◽  
Original Approach

Purpose Health and social care facilities are usually complex buildings that require continuous effort to provide resilient and sustainable responses to changes in demographics, technologies, diseases and models of care. Despite resilience and sustainability concepts being frequently used by practitioners and researchers, ambiguities in their definitions often result in a lack of operational solutions to record, monitor and improve the resilience and sustainability of health and social care facilities. Although the importance and complexity of the issues are widely acknowledged, there is little strategic guidance as to how they should be achieved. The purpose of this paper is to assess the suitability of developing a roadmap for improving the resilience and sustainability of UK health and social care facilities, and to identify the layers and processes needed to construct such a roadmap. Design/methodology/approach A qualitative approach was adopted, starting with a literature review of different types of roadmaps and their suitability to support the desired improvement objectives. Layers and processes were thus developed using the key issues identified in three recent research streams, and the roadmap was structured. Findings The major findings have been captured within a three-layer, four-step process generic roadmap for improving the resilience and sustainability of health and social care facilities that can be used to monitor performance, plans future actions and implement response to change. Practical implications This paper targets decision makers, especially estate managers, but the proposed layers and processes can be modified for other stakeholders. Originality/value This paper suggests an original approach for the development of a roadmap for resilience and sustainability of health and social care facilities, and specifically of how to structure layers and processes, envisioning a more integrated development of service provision and infrastructure asset management.

scholarly journals The Impact of Changing the CMS Nursing Home Compare 5-Star Ratings on the Use of Antipsychotics

2020 ◽  
Vol 4 (Supplement_1) ◽  
pp. 43-43
Author(s):  
Shekinah Fashaw ◽  
Theresa Shireman ◽  
Ellen McCreedy ◽  
Jessica Ogarek
Keyword(s):  
Policy Decision ◽  
Interrupted Time Series ◽  
Significant Drop ◽  
Data Set ◽  
People With Dementia ◽  
Quasi Experimental ◽  
Race Ethnicity ◽  
Rate Of Decline ◽  
National Partnership ◽  
The Impact

Abstract Due to their potential to increase falls and death in people with dementia, antipsychotic medications (APMs) have been the subject of several federal efforts to reduce their use in nursing homes (NHs). In 2015, the Centers for Medicare & Medicaid Services added inappropriate APM use to their NH 5-star quality ratings. We examined the impact of this policy decision on NH residents with dementia by race/ethnicity. Using a quasi-experimental study design and Minimum Data Set (MDS) 3.0 assessments, we examined long-stay NH residents with dementia. We examined changes in APM use quarterly (2013-2016) using interrupted time series analyses, stratified by race/ethnicity. There were about 1 million NH residents per quarter. Baseline use of APMs among persons with dementia was 29.1% for Whites, 29.2% for Blacks, and 33.7% for Hispanics. All three races experienced significant declines in APM use prior to the addition of AP use into the quality rating (p&lt;0.001). During the first quarter of rating system changes, there were significant declines in APM use for all three races: Blacks, 0.48%; Hispanics, 1.0%; Whites, 0.49%. Subsequent rates of decrease in APM use did not differ from the baseline rate of decline (p&gt; 0.5). The policy change did result in a one-time, significant drop in APM use, but did not alter the rate of decline already in place, presumably stemming from the National Partnership instituted in 2012. Hispanics started with the highest rate of APM use and experienced the greatest decreases over time and with the new star rating measure.

scholarly journals Patient-Reported Measures for Person-Centered Coordinated Care: A Comparative Domain Map and Web-Based Compendium for Supporting Policy Development and Implementation (Preprint)

2017 ◽  
Author(s):  
Helen Lloyd ◽  
Hannah Wheat ◽  
Jane Horrell ◽  
Thavapriya Sugavanam ◽  
Benjamin Fosh ◽  
...  
Keyword(s):  
Stakeholder Engagement ◽  
Social Care ◽  
Models Of Care ◽  
Coordinated Care ◽  
Care Policy ◽  
Eligibility Criteria ◽  
Web Based ◽  
Health And Social Care ◽  
Patient Reported ◽  
User Friendly

BACKGROUND Patient-reported measure (PRM) questionnaires were originally used in research to measure outcomes of intervention studies. They have now evolved into a diverse family of tools measuring a range of constructs including quality of life and experiences of care. Current health and social care policy increasingly advocates their use for embedding the patient voice into service redesign through new models of care such as person-centered coordinated care (P3C). If chosen carefully and used efficiently, these tools can help improve care delivery through a variety of novel ways, including system-level feedback for health care management and commissioning. Support and guidance on how to use these tools would be critical to achieve these goals. OBJECTIVE The objective of this study was to develop evidence-based guidance and support for the use of P3C-PRMs in health and social care policy through identification of PRMs that can be used to enhance the development of P3C, mapping P3C-PRMs against an existing model of domains of P3C, and integration and organization of the information in a user-friendly Web-based database. METHODS A pragmatic approach was used for the systematic identification of candidate P3C-PRMs, which aimed at balancing comprehensiveness and feasibility. This utilized a number of resources, including existing compendiums, peer-reviewed and gray literature (using a flexible search strategy), and stakeholder engagement (which included guidance for relevant clinical areas). A subset of those candidate measures (meeting prespecified eligibility criteria) was then mapped against a theoretical model of P3C, facilitating classification of the construct being measured and the subsequent generation of shortlists for generic P3C measures, specific aspects of P3C (eg, communication or decision making), and condition-specific measures (eg, diabetes, cancer) in priority areas, as highlighted by stakeholders. RESULTS In total, 328 P3C-PRMs were identified, which were used to populate a freely available Web-based database. Of these, 63 P3C-PRMs met the eligibility criteria for shortlisting and were classified according to their measurement constructs and mapped against the theoretical P3C model. We identified tools with the best coverage of P3C, thereby providing evidence of their content validity as outcome measures for new models of care. Transitions and medications were 2 areas currently poorly covered by existing measures. All the information is currently available at a user-friendly web-based portal (p3c.org.uk), which includes all relevant information on each measure, such as the constructs targeted and links to relevant literature, in addition to shortlists according to relevant constructs. CONCLUSIONS A detailed compendium of P3C-PRMs has been developed using a pragmatic systematic approach supported by stakeholder engagement. Our user-friendly suite of tools is designed to act as a portal to the world of PRMs for P3C, and have utility for a broad audience, including (but not limited to) health care commissioners, managers, and researchers.

Sign in / Sign up

Export Citation Format

Share Document