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Pitchforth E, Nolte E, Corbett J, Miani C, Winpenny E, van Teijlingen E, Elmore N, King S, Ball S, Miler J, Ling T. Community hospitals and their services in the NHS: identifying transferable learning from international developments – scoping review, systematic review, country reports and case studies. HEALTH SERVICES AND DELIVERY RESEARCH 2017. [DOI: 10.3310/hsdr05190] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
BackgroundThe notion of a community hospital in England is evolving from the traditional model of a local hospital staffed by general practitioners and nurses and serving mainly rural populations. Along with the diversification of models, there is a renewed policy interest in community hospitals and their potential to deliver integrated care. However, there is a need to better understand the role of different models of community hospitals within the wider health economy and an opportunity to learn from experiences of other countries to inform this potential.ObjectivesThis study sought to (1) define the nature and scope of service provision models that fit under the umbrella term ‘community hospital’ in the UK and other high-income countries, (2) analyse evidence of their effectiveness and efficiency, (3) explore the wider role and impact of community engagement in community hospitals, (4) understand how models in other countries operate and asses their role within the wider health-care system, and (5) identify the potential for community hospitals to perform an integrative role in the delivery of health and social care.MethodsA multimethod study including a scoping review of community hospital models, a linked systematic review of their effectiveness and efficiency, an analysis of experiences in Australia, Finland, Italy, Norway and Scotland, and case studies of four community hospitals in Finland, Italy and Scotland.ResultsThe evidence reviews found that community hospitals provide a diverse range of services, spanning primary, secondary and long-term care in geographical and health system contexts. They can offer an effective and efficient alternative to acute hospitals. Patient experience was frequently reported to be better at community hospitals, and the cost-effectiveness of some models was found to be similar to that of general hospitals, although evidence was limited. Evidence from other countries showed that community hospitals provide a wide spectrum of health services that lie on a continuum between serving a ‘geographic purpose’ and having a specific population focus, mainly older people. Structures continue to evolve as countries embark on major reforms to integrate health and social care. Case studies highlighted that it is important to consider local and national contexts when looking at how to transfer models across settings, how to overcome barriers to integration beyond location and how the community should be best represented.LimitationsThe use of a restricted definition may have excluded some relevant community hospital models, and the small number of countries and case studies included for comparison may limit the transferability of findings for England. Although this research provides detailed insights into community hospitals in five countries, it was not in its scope to include the perspective of patients in any depth.ConclusionsAt a time when emphasis is being placed on integrated and community-based care, community hospitals have the potential to assume a more strategic role in health-care delivery locally, providing care closer to people’s homes. There is a need for more research into the effectiveness and cost-effectiveness of community hospitals, the role of the community and optimal staff profile(s).FundingThe National Institute for Health Research Health Services and Delivery Research programme.
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Affiliation(s)
- Emma Pitchforth
- Cambridge Centre for Health Services Research (CCHSR), RAND Europe, Cambridge, UK
| | - Ellen Nolte
- European Observatory on Health Systems and Policies, London School of Economics and Political Science and London School of Hygiene & Tropical Medicine, London, UK
| | - Jennie Corbett
- Cambridge Centre for Health Services Research (CCHSR), RAND Europe, Cambridge, UK
| | - Céline Miani
- Cambridge Centre for Health Services Research (CCHSR), RAND Europe, Cambridge, UK
| | - Eleanor Winpenny
- Cambridge Centre for Health Services Research (CCHSR), RAND Europe, Cambridge, UK
| | - Edwin van Teijlingen
- Department of Human Sciences and Public Health, University of Bournemouth, Bournemouth, UK
| | - Natasha Elmore
- Cambridge Centre for Health Services Research (CCHSR), Institute of Public Health, University of Cambridge, Cambridge, UK
| | | | - Sarah Ball
- Cambridge Centre for Health Services Research (CCHSR), RAND Europe, Cambridge, UK
| | - Joanna Miler
- Cambridge Centre for Health Services Research (CCHSR), RAND Europe, Cambridge, UK
- Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - Tom Ling
- Cambridge Centre for Health Services Research (CCHSR), RAND Europe, Cambridge, UK
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Wang Y, Stavem K, Humerfelt S, Dahl FA, Haugen T. Readmissions for COPD: propensity case-matched comparison between pulmonary and non-pulmonary departments. THE CLINICAL RESPIRATORY JOURNAL 2013; 7:375-81. [PMID: 23347439 DOI: 10.1111/crj.12018] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/03/2012] [Revised: 12/03/2012] [Accepted: 12/16/2012] [Indexed: 11/30/2022]
Abstract
INTRODUCTION Acute exacerbation of chronic obstructive pulmonary disease (AECOPD) is a common cause of hospitalisation, and the readmission rate is high. We aimed to determine whether patients discharged from a pulmonary department (PD) after an AECOPD episode had a lower COPD-related readmission rate during the next 12 months than comparable patients discharged from other internal medicine departments (ODs). METHODS The medical records of 566 patients discharged after an episode of AECOPD between March 2006 and December 2008 at Oslo University Hospital, Aker, were reviewed retrospectively. Demographic and medical data, together with number of readmissions because of AECOPD during 12 months following the index admission were extracted. We matched patients discharged from the PD and the ODs using a propensity score and used the paired t-test to compare COPD-related readmission rates between the matched patients. RESULTS In total, 481 patients were included in the analysis, 247 patients discharged from the PD and 234 from ODs. The propensity score matching process resulted in 155 well-matched pairs. The mean (standard deviation) number of readmissions within 1 year was 0.8 (1.3) for the PD versus 1.1 (1.9) for ODs (P = 0.09). After adjusting for exposure time, the corresponding readmission rates were 1.1 (2.3) and 1.6 (4.0) per year, respectively (P = 0.17). CONCLUSION There was little difference in COPD-related readmission rates between comparable patients discharged from the PD and the ODs after an AECOPD during 1 year following the index admission.
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Affiliation(s)
- Ying Wang
- HØKH, Research Centre, Akershus University Hospital, Lørenskog, Norway; Department of Pulmonary Medicine, Akershus University Hospital, Lørenskog, Norway
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