1
|
Wang YC, Chou MY, Liang CK, Peng LN, Chen LK, Loh CH. Post-Acute Care as a Key Component in a Healthcare System for Older Adults. Ann Geriatr Med Res 2019; 23:54-62. [PMID: 32743289 PMCID: PMC7387590 DOI: 10.4235/agmr.19.0009] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2019] [Revised: 03/23/2019] [Accepted: 03/26/2019] [Indexed: 11/30/2022] Open
Abstract
Older adults often experience functional decline following acute medical care. This functional decline may lead to permanent disability, which will increase the burden on the medical and long-term care systems, families, and society as a whole. Post-acute care aims to promote the functional recovery of older adults, prevent unnecessary hospital readmission, and avoid premature admission to a long-term care facility. Research has shown that post-acute care is a cost-effective service model, with both the hospital-at-home and community hospital post-acute care models being highly effective. This paper describes the post-acute care models of the United States and the United Kingdom and uses the example of Taiwan’s highly effective post-acute care system to explain the benefits and importance of post-acute care. In the face of rapid demographic aging and smaller household size, a post-acute care system can lower medical costs and improve the health of older adults after hospitalization.
Collapse
Affiliation(s)
- Yu-Chun Wang
- Center for Geriatrics and Gerontology, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan
| | - Ming-Yueh Chou
- Center for Geriatrics and Gerontology, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan.,Aging and Health Research Center, National Yang Ming University, Taipei, Taiwan.,Department of Geriatric Medicine, National Yang Ming University, Taipei, Taiwan
| | - Chih-Kuang Liang
- Center for Geriatrics and Gerontology, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan.,Aging and Health Research Center, National Yang Ming University, Taipei, Taiwan.,Department of Geriatric Medicine, National Yang Ming University, Taipei, Taiwan
| | - Li-Ning Peng
- Aging and Health Research Center, National Yang Ming University, Taipei, Taiwan.,Department of Geriatric Medicine, National Yang Ming University, Taipei, Taiwan.,Center for Geriatrics and Gerontology, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Liang-Kung Chen
- Aging and Health Research Center, National Yang Ming University, Taipei, Taiwan.,Department of Geriatric Medicine, National Yang Ming University, Taipei, Taiwan.,Center for Geriatrics and Gerontology, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Ching-Hui Loh
- Department of Geriatric Medicine, National Yang Ming University, Taipei, Taiwan.,Center for Aging and Community Health, Hualien Tzu Chi Hospital, Hualien, Taiwan.,School of Medicine, Tzu Chi University, Hualien, Taiwan
| |
Collapse
|
2
|
Nicolini A, Stieglitz S, Bou-Khalil P, Esquinas A. Cost-utility of non-invasive mechanical ventilation: Analysis and implications in acute respiratory failure. A brief narrative review. Respir Investig 2018; 56:207-213. [PMID: 29773291 DOI: 10.1016/j.resinv.2017.12.011] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2017] [Revised: 11/09/2017] [Accepted: 12/20/2017] [Indexed: 10/18/2022]
Abstract
The growing interest in the quality of patient care at the levels of the health care managers, insurance companies, and health professionals is evident. Further, the growing population requires good quality health services. In this review, we analyzed the cost-effectiveness of noninvasive ventilation (NIV) in an acute setting for the treatment of respiratory failure. The strength of this review is that it identified and summarized the most relevant studies regarding various aspects of the cost-utility of NIV in an acute setting. This is the first review that focuses on the importance of the skills and training of the team in the reduction of costs associated with NIV. However, the small number of studies, heterogeneity of quality, and different outcomes of the different studies are the greatest limitations of this review. In conclusion, although there is great variation in the data drawn from the literature, NIV seems to be a cost-effective tool, especially in specific patients (those with chronic obstructive pulmonary disease) for whom the addition of NIV improves outcomes and has a positive impact on this expenditure.
Collapse
Affiliation(s)
- Antonello Nicolini
- Respiratory Diseases Unit, General Hospital, Via Terzi 43, 16039 Sestri Levante, Italy.
| | - Sven Stieglitz
- Department of Pulmonology and Cardiology, Petrus Hospital Academic Teaching, Wuppertal, Germany
| | - Pierre Bou-Khalil
- Division of Pulmonary and Critical Care, Department of Internal Medicine, American University of Beirut Medical Center, Lebanon
| | | |
Collapse
|
3
|
Fillmore Elbourne H, le May A. Crafting intermediate care: one team’s journey towards integration and innovation. J Res Nurs 2015. [DOI: 10.1177/1744987114568656] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Aim This paper describes one multi-disciplinary, multi-agency team’s development of Person-Centred Intermediate Care (PCIC) for older people. This development involved integrating three separate enterprises – a not-for-profit charitable organisation, a local primary health care trust and referring hospitals and their local social care providers. Methods We used a mixed-methods case study, underpinned by the notion of an innovation journey, to explore how PCIC was developed by the team and how effective it was. Data were collected through semi-structured interviews, documentary analysis, closed-end questionnaires/scales and routinely collected activity data. Thematic and statistical analyses were used. Results were triangulated. Twelve staff, four key informants and 94 service users participated. Results The development followed the trajectory of innovation journeys. Our mixed-methods approach enabled us to expose staff’s negative experiences during this time whilst patients were largely satisfied with their care and made appropriate recovery. The triangulation of data in this mixed-methods study allowed us to seek explanations for this mismatch. We conjecture that the staff used emotional labour to lessen the effects of their negative experiences for the benefit of the patients. Conclusions This paper extends our knowledge of how, in a policy environment that encourages collaborative practice between public, private and voluntary alliances, and across sectors, such innovations work. In addition, the results suggest that emotional labour is used during change and care practices: preparing nurses better in order to use this ‘technique’ is a recommendation from this research.
Collapse
Affiliation(s)
| | - Andrée le May
- Retired Professor of Nursing at the University of Southampton, UK
| |
Collapse
|
4
|
Bohmer RMJ, Imison C. Lessons from England's health care workforce redesign: no quick fixes. Health Aff (Millwood) 2014; 32:2025-31. [PMID: 24191096 DOI: 10.1377/hlthaff.2013.0553] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
In 2000 the English National Health Service (NHS) began a series of workforce redesign initiatives that increased the number of doctors and nurses serving patients, expanded existing staff roles and developed new ones, redistributed health care work, and invested in teamwork. The English workforce redesign experience offers important lessons for US policy makers. Redesigning the health care workforce is not a quick fix to control costs or improve the quality of care. A poorly planned redesign can even result in increased costs and decreased quality. Changes in skill mix and role definitions should be preceded by a detailed analysis and redesign of the work performed by health care professionals. New roles and responsibilities must be clearly defined in advance, and teamwork models that include factors common in successful redesigns such as leadership, shared objectives, and training should be promoted. The focus should be on retraining current staff instead of hiring new workers. Finally, any workforce redesign must overcome opposition from professional bodies, individual practitioners, and regulators. England's experience suggests that progress is possible if workforce redesigns are planned carefully and implemented with skill.
Collapse
|
5
|
Brusco NK, Taylor NF, Watts JJ, Shields N. Economic Evaluation of Adult Rehabilitation: A Systematic Review and Meta-Analysis of Randomized Controlled Trials in a Variety of Settings. Arch Phys Med Rehabil 2014; 95:94-116.e4. [DOI: 10.1016/j.apmr.2013.03.017] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2013] [Revised: 03/14/2013] [Accepted: 03/14/2013] [Indexed: 12/01/2022]
|
6
|
Johannessen AK, Werner A, Steihaug S. Work in an intermediate unit: balancing between relational, practical and moral care. J Clin Nurs 2013; 23:586-95. [DOI: 10.1111/jocn.12213] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/29/2012] [Indexed: 11/27/2022]
Affiliation(s)
| | - Anne Werner
- Health Services Research Centre; Akershus University Hospital; Lørenskog Norway
| | - Sissel Steihaug
- Health Services Research Centre; Akershus University Hospital; Lørenskog Norway
- SINTEF Technology and Society; Health Research; Blindern Norway
| |
Collapse
|
7
|
Farag I, Sherrington C, Ferreira M, Howard K. A systematic review of the unit costs of allied health and community services used by older people in Australia. BMC Health Serv Res 2013; 13:69. [PMID: 23421756 PMCID: PMC3586358 DOI: 10.1186/1472-6963-13-69] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2012] [Accepted: 02/19/2013] [Indexed: 11/25/2022] Open
Abstract
Background An economic evaluation of interventions for older people requires accurate assessment of costing and consideration of both acute and long-term services. Accurate information on the unit cost of allied health and community services is not readily available in Australia however. This systematic review therefore aims to synthesise information available in the literature on the unit costs of allied health and community services that may be utilised by an older person living in Australia. Method A comprehensive search of Medline, Embase, CINAHL, Google Scholar and Google was undertaken. Specialised economic databases were also reviewed. In addition Australian Government Department websites were inspected. The search identified the cost of specified allied health services including: physiotherapy, occupational therapy, dietetics, podiatry, counselling and home nursing. The range of community services included: personal care, meals on wheels, transport costs and domestic services. Where the information was not available, direct contact with service providers was made. Results The number of eligible studies included in the qualitative synthesis was fourty-nine. Calculated hourly rates for Australian allied health services were adjusted to be in equivalent currency and were as follows as follows: physiotherapy $157.75, occupational therapy $150.77, dietetics $163.11, psychological services $165.77, community nursing $105.76 and podiatry $129.72. Conclusions Utilisation of the Medicare Benefits Scheduled fee as a broad indicator of the costs of services, may lead to underestimation of the real costs of services and therefore to inaccuracies in economic evaluation.
Collapse
Affiliation(s)
- Inez Farag
- George Institute for Global Health, University of Sydney, 321 Kent Street, Sydney, NSW 2006, Australia.
| | | | | | | |
Collapse
|
8
|
Johannessen AK, Lurås H, Steihaug S. The role of an intermediate unit in a clinical pathway. Int J Integr Care 2013; 13:e012. [PMID: 23687484 PMCID: PMC3653277 DOI: 10.5334/ijic.859] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2012] [Revised: 11/28/2012] [Accepted: 12/19/2012] [Indexed: 11/20/2022] Open
Abstract
INTRODUCTION Different care models have been established to achieve more coordinated clinical pathways for older patients in the transition between hospital and home. This study explores an intermediate unit's role in a clinical pathway for older patients with somatic diseases. THEORY AND METHODS Qualitative data were collected via interviews, observations, and a questionnaire. Participants included patients and healthcare providers within both specialist and primary healthcare. Transcripts of interviews and field notes were analyzed using a method of systematic text condensation. RESULTS Healthcare providers in the hospital, the intermediate unit, and the municipalities have different opinions about who is a 'suitable' patient for the unit and what is the proper time for hospital discharge. This results in time-consuming negotiations between the hospital and the unit. Incompatible computer systems increase the healthcare provider's workload. Several informants are doubtful as to whether a stay in the unit is useful to the patients, while the patients are mostly pleased with their stay and the transferral. CONCLUSION AND DISCUSSION This study describes challenges that may occur when a new unit is established in an existing healthcare system in order to achieve an appropriate clinical pathway from hospital to home.
Collapse
|
9
|
Linde C, Mealing S, Hawkins N, Eaton J, Brown B, Daubert JC. Cost-effectiveness of cardiac resynchronization therapy in patients with asymptomatic to mild heart failure: insights from the European cohort of the REVERSE (Resynchronization Reverses remodeling in Systolic Left Ventricular Dysfunction). Eur Heart J 2010; 32:1631-9. [DOI: 10.1093/eurheartj/ehq408] [Citation(s) in RCA: 53] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
|
10
|
Abstract
Intermediate care (IC) has been government policy for implementation in the U.K. for almost 10 years. It was hoped that it would help free up acute hospital resources. However, admission rates continue to rise and are rising fastest in those over the age of 75. Many different models of IC have been tried. Typically, outcomes are very similar to traditional hospital care and they tend to be met with high patient satisfaction. Yet there is no evidence that they reduce acute hospital use or that they are cost efficient. Maybe it is time to rethink our national strategy on this issue?
Collapse
|
11
|
Abstract
The origins of intermediate care as a health policy in England are reviewed. The randomized controlled trial (RCT) evidence for the various intermediate care service models is discussed from the perspectives of clinical, service and economic outcomes. This evidence base suggests that the hospital-at-home approach is currently the best RCT supported intermediate care service model. It is argued that intermediate care in England has yet to fulfil its expectations. Changing staff skills and attitudes has proved a challenge, and the integration of intermediate care with mainstream services has been especially difficult. New national guidance has been produced that is attempting to refocus intermediate care its intended target group of frail older people, and not to specifically exclude older people with mental health problems.
Collapse
Affiliation(s)
- John Young
- Academic Unit of Elderly Care and Rehabilitation, Bradford Institute for Health Research, Bradford Royal Imfirmary, Duckworth Lane, Bradford BD9 6RJ, UK.
| |
Collapse
|
12
|
Schadewaldt V, Schultz T. A systematic review on the effectiveness of nurse-led cardiac clinics for adult patients with coronary heart disease. ACTA ACUST UNITED AC 2010; 8:53-89. [DOI: 10.11124/01938924-201008020-00001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
|
13
|
Kaambwa B, Bryan S, Barton P, Parker H, Martin G, Hewitt G, Parker S, Wilson A. Costs and health outcomes of intermediate care: results from five UK case study sites. HEALTH & SOCIAL CARE IN THE COMMUNITY 2008; 16:573-581. [PMID: 18384358 DOI: 10.1111/j.1365-2524.2008.00780.x] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
The objectives of this study were to explore the costs and outcomes associated with different types of intermediate care (IC) services, and also to examine the characteristics of patients receiving such services. Five UK case studies of 'whole systems' of IC were used, with data collected on a sample of consecutive IC episodes between January 2003 and January 2004. Statistical differences in costs and outcomes associated with different IC services and patient groups were explored. Factors associated with variation in IC episode outcomes (EuroQol EQ-5D and Barthel Index) were explored using an econometric framework. Data were available for 2253 episodes of IC. In terms of Department of Health criteria, a large proportion of patients (up to 47% of those for whom data were available) in this study were inappropriately admitted to IC services. As regards service function, compared to supported discharge, admission avoidance services were associated with both lower costs and greater health and functional gains. These gains appear to be driven, in part, by illness severity (more dependent patients tended to gain most benefit). In addition, these gains appear to be larger where the admission was appropriate. Our work suggests a need for the development and application of robust and reliable clinical criteria for admission to IC, and close co-operation between hospital and community service providers over selection of patients and targeting of IC and acute care services to meet defined clinical need.
Collapse
Affiliation(s)
- Billingsley Kaambwa
- Formerly Health Economics Facility, Health Services Management Centre, University of Birmingham, Park House, 40 Edgbaston Park Road, Birmingham, B15 2RT, UK
| | | | | | | | | | | | | | | |
Collapse
|
14
|
Sturgeon D. Advanced nursing practice and Newton's three laws of motion. BRITISH JOURNAL OF NURSING (MARK ALLEN PUBLISHING) 2008; 17:706-710. [PMID: 18773586 DOI: 10.12968/bjon.2008.17.11.29616] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
This article considers the reasons for the development of advanced practice roles among nurses and other healthcare professions. It explores the implications of financial constraints, consumer preferences and the development of new healthcare services on the reorganization of professional boundaries. It makes use of Sir Isaac Newton's three laws of motion to demonstrate how professional development in nursing has taken place in response to a number of external influences and demands. It also considers the significance of skill mix for the nursing profession, in particular the development and likely expansion of the physician assistant role. The application of different professionals and grades within a healthcare team or organization is central to the Government's Agenda for Change proposals and nurses have successfully adopted a number of roles traditionally performed by doctors. Nurses have demonstrated that they are capable of providing high quality care and contributing directly to positive patient outcome. Advanced nursing roles should not only reflect the changing nature of healthcare work, they should also be actively engaged in reconstructing healthcare boundaries.
Collapse
Affiliation(s)
- David Sturgeon
- Department of Nursing and Applied Clinical Sciences, Canterbury Christ Church University, Canterbury
| |
Collapse
|
15
|
Garåsen H, Windspoll R, Johnsen R. Long-term patients' outcomes after intermediate care at a community hospital for elderly patients: 12-month follow-up of a randomized controlled trial. Scand J Public Health 2008; 36:197-204. [PMID: 18519285 DOI: 10.1177/1403494808089685] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Developing a better understanding of if, and when, patients need care at a general hospital is an urgent challenge, as the proportion of general hospital beds being occupied by older patients is continuously increasing. METHODS In a randomized controlled trial, of 142 patients aged 60 years or more admitted to a city general hospital due to acute illness or exacerbation of a chronic disease, 72 (intervention group) were randomized to intermediate care at a community hospital, and 70 (general hospital group) to further general hospital care. The patients were followed up for 12 months. The need for long-term home care and nursing homes, mortality and the number of admissions and days in general hospital for all diseases were monitored. RESULTS Thirty-five patients, 13 (18.1%) of the patients included in the intervention group and 22 (31.4%) in the general hospital group, died within 12 months (p=0.03). Patients in the intervention group were observed for a longer period of time than those in the general hospital group; 335.7 (95% confidence interval (CI) 312.0-359.4) vs. 292.8 (95% CI 264.1-321.5) days (p=0.01). There were statistically no differences in the need for long-term primary-level care or in the number of admissions or days spent in general hospital beds. CONCLUSIONS Intermediate care at the community hospital in Trondheim is an equal alternative to ordinary prolonged care at the city general hospital, as fewer patients were in need of community care services, and significantly fewer patients died during the 12-month follow-up time.
Collapse
Affiliation(s)
- Helge Garåsen
- Department of Public Health and General Practice, Faculty of Medicine, The Norwegian University of Science and Technology (NTNU), Trondheim, Norway.
| | | | | |
Collapse
|
16
|
THOMAS VALERIE, LAMBERT SUSAN. An ethnographic study of intermediate care services in Wales: the hidden work. J Nurs Manag 2008; 16:181-7. [DOI: 10.1111/j.1365-2834.2008.00846.x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
|
17
|
Garåsen H, Windspoll R, Johnsen R. Intermediate care at a community hospital as an alternative to prolonged general hospital care for elderly patients: a randomised controlled trial. BMC Public Health 2007; 7:68. [PMID: 17475006 PMCID: PMC1868721 DOI: 10.1186/1471-2458-7-68] [Citation(s) in RCA: 55] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2007] [Accepted: 05/02/2007] [Indexed: 11/28/2022] Open
Abstract
Background Demographic changes together with an increasing demand among older people for hospital beds and other health services make allocation of resources to the most efficient care level a vital issue. The aim of this trial was to study the efficacy of intermediate care at a community hospital compared to standard prolonged care at a general hospital. Methods In a randomised controlled trial 142 patients aged 60 or more admitted to a general hospital due to acute illness or exacerbation of a chronic disease 72 (intervention group) were randomised to intermediate care at a community hospital and 70 (general hospital group) to further general hospital care. Results In the intervention group 14 patients (19.4%) were readmitted for the same disease compared to 25 patients (35.7%) in the general hospital group (p = 0.03). After 26 weeks 18 (25.0%) patients in the intervention group were independent of community care compared to seven (10.0%) in the general hospital group (p = 0.02). There were an insignificant reduction in the number of deaths and an insignificant increase in the number of days with inward care in the intervention group. The number of patients admitted to long-term nursing homes from the intervention group was insignificantly higher than from the general hospital group. Conclusion Intermediate care at a community hospital significantly decreased the number of readmissions for the same disease to general hospital, and a significantly higher number of patients were independent of community care after 26 weeks of follow-up, without any increase in mortality and number of days in institutions.
Collapse
Affiliation(s)
- Helge Garåsen
- Department of Public Health and General Practice, Faculty of Medicine, The Norwegian University of Science and Technology (NTNU), 7491 Trondheim, Norway
| | | | - Roar Johnsen
- Department of Public Health and General Practice, Faculty of Medicine, The Norwegian University of Science and Technology (NTNU), 7491 Trondheim, Norway
| |
Collapse
|
18
|
Griffiths PD, Edwards MH, Forbes A, Harris RL, Ritchie G. Effectiveness of intermediate care in nursing-led in-patient units. Cochrane Database Syst Rev 2007; 2007:CD002214. [PMID: 17443516 PMCID: PMC7017859 DOI: 10.1002/14651858.cd002214.pub3] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
BACKGROUND The Nursing led inpatient Unit (NLU) is one of a range of services that have been considered in order to manage more successfully the transition between hospital and home for patients with extended recovery times. This is an update of an earlier review published in The Cochrane Library in Issue 3, 2004. OBJECTIVES To determine whether nursing-led inpatient units are effective in preparing patients for discharge from hospital compared to usual inpatient care. SEARCH STRATEGY We searched The Cochrane Library, the Specialized Register of the Cochrane Effective Practice and Organisation of Care (EPOC) group, MEDLINE, CINAHL, EMBASE, BNI and HMIC databases. Citation searches were undertaken on the science and social science citation indices. Authors were contacted to identify additional data. The initial search was done in January 2001. The register search was updated in October 2006, the other database searches were updated in November 2006 and the citation search was run in January 2007. SELECTION CRITERIA Controlled trials and interrupted time series designs that compared the NLU to usual inpatient care managed by doctors. Patients over 18 years of age following an acute hospital admission for a physical health condition. DATA COLLECTION AND ANALYSIS Two reviewers independently extracted data and assessed study quality. MAIN RESULTS Ten random or quasi-random controlled trials reported on a total of 1896 patients. There was no statistically significant effect on inpatient mortality (OR 1.10, 95% CI 0.56 to 2.16) or mortality to longest follow up (OR 0.92, 95% CI 0.65 to 1.29) but higher quality studies showed a larger non-significant increase in inpatient mortality (OR 1.52, 95% CI 0.86 to 2.68). Discharge to institutional care was reduced for the NLU (OR 0.44 95% CI 0.22 to 0.89) and functional status at discharge increased (SMD 0.37, 95% CI 0.20 to 0.54) but there was a near significant increase in inpatient stay (WMD 5.13 days 95% CI -0.5 days to 10.76 days). Early readmissions were reduced (OR 0.52 95% CI 0.34 to 0.80). One study compared a NLU for the chronically critically ill with ICU care. Mortality (OR 0.62 95% CI 0.35 to 1.10) and length of inpatient stay differ did not differ (WMD 2 days, 95% CI 10.96 to -6.96 days). Early readmissions were reduced (OR 0.33 95% CI 0.12 to 0.94). Costs of care on the NLU were higher for UK studies but lower for US based studies. AUTHORS' CONCLUSIONS There is some evidence that patients discharged from a NLU are better prepared for discharge but it is unclear if this is simply a product of an increased length of inpatient stay. No statistically significant adverse effects were noted but the possibility of increased early mortality cannot be discounted. More research is needed.
Collapse
Affiliation(s)
- P D Griffiths
- King's College London, School of Nursing and Midwifery, Room 3.29b JCMB, Waterloo Road, London, UK, SE1 8WA.
| | | | | | | | | |
Collapse
|
19
|
Martin GP, Hewitt GJ, Faulkner TA, Parker H. The organisation, form and function of intermediate care services and systems in England: results from a national survey. HEALTH & SOCIAL CARE IN THE COMMUNITY 2007; 15:146-54. [PMID: 17286676 DOI: 10.1111/j.1365-2524.2006.00669.x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/13/2023]
Abstract
This paper reports the results of a postal survey of intermediate care coordinators (ICCs) on the organisation and delivery of intermediate care services for older people in England, conducted between November 2003 and May 2004. Questionnaires, which covered a range of issues with a variety of quantitative, tick-box and open-ended questions, were returned by 106 respondents, representing just over 35% of primary care trusts (PCTs). The authors discuss the role of ICCs, the integration of local systems of intermediate care provision, and the form, function and model of delivery of services described by respondents. Using descriptive and statistical analysis of the responses, they highlight in particular the relationship between provision of admission avoidance and supported discharge, the availability of 24-hour care, and the locations in which care is provided, and relate their findings to the emerging evidence base for intermediate care, guidance on implementation from central government, and debate in the literature. Whilst the expansion and integration of intermediate care appear to be continuing apace, much provision seems concentrated in supported discharge services rather than acute admission avoidance, and particularly in residential forms of post-acute intermediate care. Supported discharge services tend to be found in residential settings, while admission avoidance provision tends to be non-residential in nature. Twenty-four-hour care in non-residential settings is not available in several responding PCTs. These findings raise questions about the relationship between the implementation of intermediate care, and the evidence for and aims of the policy as part of National Health Service modernisation, and the extent to which intermediate care represents a genuinely novel approach to the care and rehabilitation of older people.
Collapse
Affiliation(s)
- Graham P Martin
- Institute for the Study of Genetics, Biorisks and Society, University of Nottingham, Nottingham, UK.
| | | | | | | |
Collapse
|
20
|
|
21
|
Abstract
This mini-review provides an overview of evidence regarding the effectiveness, costs and patient experience relating the intermediate care in nursing-led units. The core of the evidence is derived from a high quality systematic review of 10 controlled trials involving 1669 patients. Other studies on patient experience and costs not included in the review are also considered. There is some evidence of patient benefit in the short term in terms of independence. However this does not seem to be sustained. Total inpatient stay is increased and hence overall costs of the initial episode are increased with no evidence of longer-term savings. The approach seems to be broadly acceptable to patients. Provided it is not simply used to house patients who cannot benefit, nursing-led units may be a viable alternative to acute care for some patients. However, the core features of the units that provided the evidence must be considered in order to maximize the potential for delivering quality care.
Collapse
Affiliation(s)
- Peter Griffiths
- King's College London, Florence Nightingale School of Nursing and Midwifery.
| |
Collapse
|
22
|
Harris R, Richardson G, Griffiths P, Hallett N, Wilson-Barnett J. Economic evaluation of a nursing-led inpatient unit: the impact of findings on management decisions of service utility and sustainability. J Nurs Manag 2005; 13:428-38. [PMID: 16108781 DOI: 10.1111/j.1365-2834.2005.00589.x] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
AIMS The nursing-led inpatient unit is designed to substitute for a period of care in acute hospital wards and to improve patient outcome prior to discharge to the community. This paper aims to evaluate the cost, from the UK National Health Service perspective, of transfer to a nursing-led inpatient unit for intermediate care and to discuss the impact of these findings to the future development and sustainability of the nursing-led inpatient unit. BACKGROUND Recent economic analyses have showed that nursing-led inpatient units are associated with increased costs of care with length of stay as the main driver of inpatient costs. METHOD The cost-effectiveness analysis was part of a randomized-controlled trial with a sample size of 175, of which 89 were in the nursing-led inpatient unit arm and 86 in the control arm. Resource use data included length of stay, investigations performed, multiprofessional input and nursing input. Clinical outcome was measured using Barthel Index, a functional status measure. RESULTS Cost per day was lower on the nursing-led inpatient unit although cost per hospital stay was higher due to significantly increased length of stay. Postdischarge community care costs were lower. The incremental cost-effectiveness ratio of the treatment was 1044 pounds sterling per point improvement of the Barthel Index. CONCLUSIONS The nursing-led inpatient unit was associated with higher costs however, the question of whether the nursing-led inpatient unit is cost-effective has not been clearly answered because of the limited follow-up period of the study. The increased cost of care on the nursing-led inpatient unit was not a major factor in local management decisions about the future of the unit. The changes in the context of service provision within which the nursing-led inpatient unit operated as a result of substantial investment in intermediate care did have a major impact.
Collapse
Affiliation(s)
- Ruth Harris
- Nursing Research Unit, King's College London, London, UK
| | | | | | | | | |
Collapse
|
23
|
|
24
|
|