Implementing a step down intermediate care service

Preconditions to implementation of an integrated care process programme

Purpose

The purpose of this study was to investigate the preconditions of a full-scale implementation of an integrated care process programme for frail older people from the staff's understanding, commitment and ability to change their work procedures with comparisons over time and between organisations.

Design/methodology/approach

A repeated cross-sectional study was conducted in a hospital, municipal health and social care setting.

Findings

Staff commitment decreased to the importance of a permanent municipal contact from baseline compared to the 12-months follow-up (p = 0.02) and the six- and 12-months follow-up (p = 0.05), to the information transfer from emergency department from the six- to the 12-months follow-up (p = 0.04), to discharge planning at the hospital at six- and 12-months follow-up (p = 0.04) and towards discharge planning at home from baseline to the six-month follow-up (p = 0.04). Significant differences occurred between the organisations about information transfer from the emergency department (p = 0.01) and discharge planning at home (p = 0.03). The hospital staff were the most committed.

Practical implications

The results can guide the implementation of complex interventions in organisations with high-employee turnover and heavy workload.

Originality/value

The study design, allowing the comparison of implementation results over time and between organisations in a later phase, gives this study a unique perspective.

Measuring the impact of step down intermediate care on delayed discharge: an interrupted time series analysis

BACKGROUND

Intermediate care (IC) acts as a bridging service between hospital and home, for those deemed medically fit for discharge but who are delayed in hospital. The aim of this study was to measure the effect of IC and a 72-hour discharge target on days delayed.

METHODS

Rate of days delayed per 1000 population aged 75 years+ in Glasgow City was compared before and after onset of IC with a 6-month phase-in period, using segmented linear regression. Inverclyde and West Dunbartonshire (IWD) was a control. Autoregressive and moving average terms were included in the model, as well as a Fourier term to adjust for seasonality.

RESULTS

Prior to IC, rate of days delayed increased in both Glasgow City and the rest of Scotland. There was a large reduction in rate of days delayed in Glasgow during the phase-in period, greater than the rest of Scotland but comparable with that observed in IWD, with subsequent increases thereafter. Adjusting for changes in IWD, the impact of IC and the discharge target in Glasgow City was a level change of -15.20 (95% CI -17.52 to -12.88) and a trend change of -0.29 (95% CI -0.55 to -0.02). This is equivalent to a predicted reduction due to IC of -16.04 days delayed per 1000 population per month, in June 2016, and a relative reduction of 35%.

CONCLUSION

IC and the 72-hour discharge target were associated with a reduction in days delayed. Rate of days delayed continued to increase over time, although at a slower rate than if IC had not been implemented.