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

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.

Download Full-text

Impact of a community respiratory service on emergency hospital admissions

European Journal of Public Health ◽

10.1093/eurpub/ckz185.304 ◽

2019 ◽

Vol 29 (Supplement_4) ◽

Author(s):

K Levin ◽

D Anderson ◽

M Milligan ◽

E Crighton

Keyword(s):

Hospital Admissions ◽

Emergency Admission ◽

Primary Diagnosis ◽

Relative Reduction ◽

Emergency Admissions ◽

Emergency Hospital ◽

Emergency Hospital Admissions ◽

North East ◽

Significant Change ◽

The Impact

Abstract Background A community respiratory service was implemented in the North West of Glasgow in January 2013, comprising a team of physiotherapists, occupational therapists and support workers, to provide education, self-management advice, and, where appropriate, treatment at home, for COPD patients, to reduce the risk of hospital admission. This study measures the impact of the service on emergency admission to hospital. Methods COPD EAs were defined as emergency admissions to hospital with a primary diagnosis of COPD. Rate of COPD EAs per 1000 population aged 65 years+ in Glasgow City was compared before and after onset of the service, using segmented linear regression with 21-month pre- and 17-month post-intervention periods. COPD EAs for residents of South and North East Glasgow (S+NE) - areas with no such service in place - were used as a comparison group. The model adjusted for the rate of all-cause emergency admissions. Autoregressive terms were included in the model, as well as a fourier term to adjust for seasonality. Models were similarly run for outcome emergency admissions with COPD in any of the other five fields of diagnosis. Results Adjusting for all cause EAs and changes in S+NE, thus factoring out the impact of other initiatives that may have affected emergency admission to hospital, the impact of the service was found to be a level change of -0.33 (-0.51, -0.16) and a trend change of -0.03 (-0.05, -0.02) COPD EAs per 1000 per month. This is equivalent to a predicted reduction due to the service of -0.88 COPD EAs per 1000 popn per month, in March 2015, and a relative reduction of 35.8%. Rate of COPD EAs per month reduced over time after the introduction of the service (from the point of full staffing). Rate of EAs with COPD in a field of diagnosis other than primary saw no significant change in level or trend associated with the service. Conclusions The community respiratory service was associated with a significant reduction in the rate of COPD EAs. Key messages The Community Respiratory service was associated with reductions in emergency hospital admissions with COPD as a primary diagnosis. There was no significant change in emergency admissions with COPD as a secondary diagnosis, suggesting hospital attendance for patients with COPD overall reduced following the intervention.

Download Full-text

Area level impacts on emergency hospital admissions of the integrated care and support pioneer programme in England: difference-in-differences analysis

BMJ Open ◽

10.1136/bmjopen-2018-026509 ◽

2019 ◽

Vol 9 (8) ◽

pp. e026509

Author(s):

Eilís Keeble ◽

M Bardsley ◽

Mary Alison Durand ◽

Ties Hoomans ◽

Nicholas Mays

Keyword(s):

Integrated Care ◽

Hospital Admissions ◽

Admission Rate ◽

Emergency Admission ◽

Difference In Differences ◽

Emergency Admissions ◽

Emergency Hospital ◽

Emergency Hospital Admissions ◽

Care And Support ◽

Health And Social Care

ObjectiveTo examine whether any differential change in emergency admissions could be attributed to integrated care by comparing pioneer and non-pioneer populations from a pre-pioneer baseline period (April 2010 to March 2013) over two follow-up periods: to 2014/2015 and to 2015/2016.DesignDifference-in-differences analysis of emergency hospital admissions from English Hospital Episode Statistics.SettingLocal authorities in England classified as either pioneer or non-pioneer.ParticipantsEmergency admissions to all NHS hospitals in England with local authority determined by area of residence of the patient.InterventionWave 1 of the integrated care and support pioneer programme announced in November 2013.Primary outcome measureChange in hospital emergency admissions.ResultsThe increase in the pioneer emergency admission rate from baseline to 2014/2015 was smaller at 1.93% and significantly different from that of the non-pioneers at 4.84% (p=0.0379). The increase in the pioneer emergency admission rate from baseline to 2015/2016 was again smaller than for the non-pioneers but the difference was not statistically significant (p=0.1879).ConclusionsIt is ambitious to expect unequivocal changes in a high level and indirect indicator of health and social care integration such as emergency hospital admissions to arise as a result of the changes in local health and social care provision across organisations brought about by the pioneers in their early years. We should treat any sign that the pioneers have had such an impact with caution. Nevertheless, there does seem to be an indication from the current analysis that there were some changes in hospital use associated with the first year of pioneer status that are worthy of further exploration.

Download Full-text

General practitioners’ and out-of-hours doctors’ role as gatekeeper in emergency admissions to somatic hospitals in Norway: registry-based observational study

BMC Health Services Research ◽

10.1186/s12913-019-4419-0 ◽

2019 ◽

Vol 19 (1) ◽

Cited By ~ 4

Author(s):

Jesper Blinkenberg ◽

Sahar Pahlavanyali ◽

Øystein Hetlevik ◽

Hogne Sandvik ◽

Steinar Hunskaar

Keyword(s):

General Practitioners ◽

Hospital Admissions ◽

Significant Proportion ◽

Emergency Admission ◽

Public Healthcare ◽

Malignant Neoplasms ◽

Cross Sectional ◽

Out Of Hours ◽

Emergency Admissions ◽

The Impact

Abstract Background Primary care doctors have a gatekeeper function in many healthcare systems, and strategies to reduce emergency hospital admissions often focus on general practitioners’ (GPs’) and out-of-hours (OOH) doctors’ role. The aim of the present study was to investigate these doctors’ role in emergency admissions to somatic hospitals in the Norwegian public healthcare system, where GPs and OOH doctors have a distinct gatekeeper function. Methods A cross-sectional analysis was performed by linking data from the Norwegian Patient Registry (NPR) and the physicians’ claims database. The referring doctor was defined as the physician who had sent a claim for a consultation with the patient within 24 h prior to an emergency admission. If there was no claim registered prior to hospital arrival, the admission was defined as direct, representing admissions from ambulance services, referrals from nursing home doctors, and admissions initiated by in-hospital doctors. Results In 2014 there were 497,587 emergency admissions to somatic hospitals in Norway after excluding birth related conditions. Direct admissions were most frequent (43%), 31% were referred by OOH doctors, 25% were referred by GPs, whereas only 2% were referred from outpatient clinics or private specialists with public contract. Direct admissions were more common in central areas (52%), here GPs’ referrals constituted only 16%. The prehospital paths varied with the hospital discharge diagnosis. For anaemias, 46–49% were referred by GPs, for acute appendicitis and mental/alcohol related disorders 52 and 49% were referred by OOH doctors, respectively. For both malignant neoplasms and cardiac arrest 63% were direct admissions. Conclusions GPs or OOH doctors referred many emergencies to somatic hospitals, and for some clinical conditions GPs’ and OOH doctors’ gatekeeping role was substantial. However, a significant proportion of the emergency admissions was direct, and this reduces the impact of the GPs’ and OOH doctors’ gatekeeper roles, even in a strict gatekeeping system.

Download Full-text

TIMELY SOCIAL CARE AND EMERGENCY HOSPITAL ADMISSIONS

Emergency Medicine Journal ◽

10.1136/emermed-2016-206139.4 ◽

2016 ◽

Vol 33 (9) ◽

pp. 678-678

Author(s):

Alison Porter ◽

Martin Bardsley ◽

David Ford ◽

John Grenfell ◽

Martin Heaven ◽

...

Keyword(s):

Social Care ◽

Hospital Admissions ◽

Emergency Hospital ◽

Emergency Hospital Admissions

Download Full-text

CAN WE REDUCE EMERGENCY HOSPITAL ADMISSIONS THROUGH EFFECTIVE SOCIAL CARE FOR OLDER PEOPLE?

Emergency Medicine Journal ◽

10.1136/emermed-2015-204980.13 ◽

2015 ◽

Vol 32 (6) ◽

pp. e16.1-e16 ◽

Cited By ~ 1

Author(s):

Alison Porter ◽

Sian Morrison-Rees

Keyword(s):

Older People ◽

Social Care ◽

Hospital Admissions ◽

Emergency Hospital ◽

Emergency Hospital Admissions ◽

Care For Older People

Download Full-text

SP3.1.5 Variation and predictors of emergency surgery in emergency hospital admissions from the Emergency Surgery Or Not (ESORT) study

British Journal of Surgery ◽

10.1093/bjs/znab361.057 ◽

2021 ◽

Vol 108 (Supplement_7) ◽

Author(s):

Andrew Hutchings ◽

Stephen O'Neill ◽

Silvia Moler Zapata ◽

Neil Smart ◽

Robert Hinchliffe ◽

...

Keyword(s):

Intestinal Obstruction ◽

Diverticular Disease ◽

Emergency Surgery ◽

Hospital Admissions ◽

Abdominal Wall Hernia ◽

Demographic Characteristics ◽

Emergency Admissions ◽

Emergency Hospital ◽

Emergency Hospital Admissions ◽

Asian Patients

Abstract Aims To assess variation in use of emergency surgery (ES) for emergency hospital admissions with acute appendicitis, cholelithiasis, diverticular disease, abdominal wall hernia or intestinal obstruction. Methods Cohorts were extracted from Hospital Episode Statistics for 136 acute NHS trusts in England. Clinical panel consensus defined ES for emergency admissions between 1/4/2010 and 31/12/2019. The association of socio-demographic characteristics with ES use was estimated by multivariable logistic regression, with adjustment for comorbidity, frailty, diagnosis and trust. Results The cohort sizes ranged from 49,385 (hernia) to 184,777 (appendicitis) patients. ES was less likely for: patients aged over 80, with odds ratios (ORs) across conditions from 0.15 to 0.84 versus those aged under 40; the most deprived, ORs 0.83 to 0.92, versus least deprived; and Asian patients, ORs 0.72 to 0.88, versus White patients. Black patients were less likely to have emergency surgery for appendicitis (OR 0.78) and cholelithiasis (OR 0.78). Females were less likely to have ES for appendicitis (OR 0.94 versus males), but more likely to have surgery for intestinal obstruction (OR 1.29), hernia (OR 1.13) and cholelithiasis (OR 1.22). Unexplained variation in ES across trusts, remained after case-mix adjustment, and was greatest for cholelithiasis (median of 16%, 10 to 90 centile 5%-34%), and hernia (61%, 52%-71%), followed by intestinal obstruction (29%, 24%-36%). appendicitis (93%, 89%-95%), and diverticular disease (15%, 11%-20%). Conclusions The socio-demographic characteristics of emergency admissions are associated with the likelihood of receiving ES. Variation in ES use between NHS trusts remained after adjustment for demographic and clinical characteristics.

Download Full-text

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

Journal of Integrated Care ◽

10.1108/14769018200800002 ◽

2008 ◽

Vol 16 (1) ◽

pp. 3-8 ◽

Cited By ~ 11

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.

Download Full-text

Associations between attainment of incentivised primary care indicators and emergency hospital admissions among type 2 diabetes patients: a population-based historical cohort study

Journal of the Royal Society of Medicine ◽

10.1177/01410768211005109 ◽

2021 ◽

pp. 014107682110051

Author(s):

Laura H Gunn ◽

Ailsa J McKay ◽

Mariam Molokhia ◽

Jonathan Valabhji ◽

German Molina ◽

...

Keyword(s):

Primary Care ◽

Hospital Admissions ◽

Historical Cohort ◽

Emergency Admissions ◽

Emergency Hospital ◽

Admission Rates ◽

Emergency Hospital Admissions ◽

Quality And Outcomes ◽

Quality And Outcomes Framework

Objectives England has invested considerably in diabetes care over recent years through programmes such as the Quality and Outcomes Framework and National Diabetes Audit. However, associations between specific programme indicators and key clinical endpoints, such as emergency hospital admissions, remain unclear. We aimed to examine whether attainment of Quality and Outcomes Framework and National Diabetes Audit primary care diabetes indicators is associated with diabetes-related, cardiovascular, and all-cause emergency hospital admissions. Design Historical cohort study. Setting A total of 330 English primary care practices, 2010–2017, using UK Clinical Practice Research Datalink. Participants A total of 84,441 adults with type 2 diabetes. Main Outcome Measures The primary outcome was emergency hospital admission for any cause. Secondary outcomes were (1) diabetes-related and (2) cardiovascular-related emergency admission. Results There were 130,709 all-cause emergency admissions, 115,425 diabetes-related admissions and 105,191 cardiovascular admissions, corresponding to unplanned admission rates of 402, 355 and 323 per 1000 patient-years, respectively. All-cause hospital admission rates were lower among those who met HbA1c and cholesterol indicators (incidence rate ratio = 0.91; 95% CI 0.89–0.92; p < 0.001 and 0.87; 95% CI 0.86–0.89; p < 0.001), respectively), with similar findings for diabetes and cardiovascular admissions. Patients who achieved the Quality and Outcomes Framework blood pressure target had lower cardiovascular admission rates (incidence rate ratio = 0.98; 95% CI 0.96–0.99; p = 0.001). Strong associations were found between completing 7–9 (vs. either 4–6 or 0–3) National Diabetes Audit processes and lower rates of all admission outcomes ( p-values < 0.001), and meeting all nine National Diabetes Audit processes had significant associations with reductions in all types of emergency admissions by 22% to 26%. Meeting the HbA1c or cholesterol Quality and Outcomes Framework indicators, or completing 7–9 National Diabetes Audit processes, was also associated with longer time-to-unplanned all-cause, diabetes and cardiovascular admissions. Conclusions Attaining Quality and Outcomes Framework-defined diabetes intermediate outcome thresholds, and comprehensive completion of care processes, may translate into considerable reductions in emergency hospital admissions. Out-of-hospital diabetes care optimisation is needed to improve implementation of core interventions and reduce unplanned admissions.

Download Full-text