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Saari H, Lönnroos E, Kautiainen H, Kokko S, Ryynänen OP, Mäntyselkä P. Incidence of short-term community hospital stays and clinical profiles of patients: the Finnish Community Hospital Cohort Study. Scand J Prim Health Care 2024; 42:82-90. [PMID: 38095573 PMCID: PMC10851795 DOI: 10.1080/02813432.2023.2291671] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/07/2023] [Accepted: 12/01/2023] [Indexed: 02/08/2024] Open
Abstract
OBJECTIVE A community hospital system covers the entire population of Finland. Yet there is little research on the system beyond routine statistics. More knowledge is needed on the incidence of hospital stays and patient profiles. We investigated the incidence of short-term community hospital stays and the features of care and patients. DESIGN Prospective observational study. SETTING Community hospitals in the catchment area of Kuopio University Hospital in Finland. SUBJECTS Short-term (up to one month) community hospital stays of adult residents. MAIN OUTCOME MEASURES The outcome was the incidence rate of short-term community hospital stays according to age, sex and the first underlying diagnoses. RESULTS A number of 13,482 short-term community hospital stays were analyzed. The patients' mean age was 77 years. The incidence rate of short-term hospital stays was 28.6 stays per 1000 person-years among residents aged <75 years and 419.0 among residents aged ≥75 years. In men aged <75 years, the hospital stay incidence was about 40% higher than in women of the same age but in residents aged ≥75 years incidences did not differ between sexes. The most common diagnostic categories were vascular and respiratory diseases, injuries and mental illnesses. CONCLUSIONS The incidence rate of short-term community hospital stays increased sharply with age and was highest among women aged ≥75 years. Care was required for acute and chronic conditions common in older adults. IMPLICATIONS Community hospitals have a substantial role in hospital care of older adults.
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Affiliation(s)
- Henna Saari
- Institute of Public Health and Clinical Nutrition, University of Eastern Finland, Kuopio, Finland
| | - Eija Lönnroos
- Institute of Public Health and Clinical Nutrition, University of Eastern Finland, Kuopio, Finland
| | | | - Simo Kokko
- Clinical Research and Trials Centre, Kuopio University Hospital, Wellbeing Services County of North Savo, Kuopio, Finland
| | - Olli-Pekka Ryynänen
- Clinical Research and Trials Centre, Kuopio University Hospital, Wellbeing Services County of North Savo, Kuopio, Finland
| | - Pekka Mäntyselkä
- Institute of Public Health and Clinical Nutrition, University of Eastern Finland, Kuopio, Finland
- Clinical Research and Trials Centre, Kuopio University Hospital, Wellbeing Services County of North Savo, Kuopio, Finland
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Bai J, Lu W. A comparative study for accessing primary healthcare between planning assessment and actual utilization for older adults: a case from Dalian City, China. Front Public Health 2023; 11:1207098. [PMID: 37744518 PMCID: PMC10513472 DOI: 10.3389/fpubh.2023.1207098] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2023] [Accepted: 08/02/2023] [Indexed: 09/26/2023] Open
Abstract
Introduction As China has rapidly evolved into an aging society, the Chinese government has developed a community-oriented primary healthcare system to vigorously expedite the transfer of primary health care (PHC) from higher-level hospitals to community health centers (CHCs). However, current planning standards for CHCs have not considered the heterogeneity of older adults in supply-demand services, such that the areas with severe aging may comprise of underestimated levels of accessibility. Methods This study focuses on the gap in PHC access between planning assessment and actual utilization for older adults. We conducted an empirical study in the city area of Dalian based on the check-in and survey data from CHCs during the COVID-19 pandemic. A comparison model was built to calculate matching probability using a modified Gaussian Two-Step Floating Catchment Area (G2SFCA) method. Results As indicated by the results, the communities in the primary healthcare shortage area (PHCSA) increased 6.8% by considering the heterogeneity of older adults; these communities with underserved PHC were ignored by the current planning assessment. Based on the comparison of actual and theoretical accessibility for older adults, we found that the average matching probability was about 76.6%, which means approximately a quarter of older adults have been misestimated the accessibility of PHC. Discussion Further analysis for the older adults with mismatched accessibility showed two causes of the gap, one is the lack of connection between the spatial distribution of facilities and the allocation of service supply, and the other is the subjective cross-catchment visit to CHCs for older adults.
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Affiliation(s)
| | - Wei Lu
- School of Architecture and Art, Dalian University of Technology, Dalian, China
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Hagen TP, Tjerbo T. The Causal Effect of Community Hospitals on General Hospital Admissions. Evaluation of a Natural Experiment Using Register Data. Int J Integr Care 2023; 23:10. [PMID: 37151780 PMCID: PMC10162362 DOI: 10.5334/ijic.6515] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2022] [Accepted: 04/21/2023] [Indexed: 05/09/2023] Open
Abstract
Background To reduce overall healthcare costs, several countries have attempted to shift services from specialist to primary care. This was also the main strategy of the Coordination Reform introduced in Norway in 2012. An important part of the reform was the introduction of Municipal Acute Wards (MAWs), a type of community hospital aimed at reducing admissions to general hospitals. The main objective of this paper is to investigate whether the implementation of MAWs had a causal effect on hospital admissions. Methods Monthly admission rates in total and by age groups for patients admitted with acute or elective conditions at internal medicine or surgical departments were analyzed using panel data regression techniques. We identified causal effects by exploiting the sequential roll out of the MAWs within fixed effect analyses. Our data covered all municipalities from start of 2010 until the end of 2017. Results The sequential implementation of the MAWs started during the summer of 2012. By the beginning of 2016 close to all municipalities had an operative MAW. The introduction of MAWs significantly reduced acute hospital admissions. The effect was strongest for patients ≥80 years admitted acutely to internal medicine departments. The effects were even stronger if the MAW had a physician on site 24/7 or was located close to a local emergency center. Conclusion Our findings suggest that this type of intermediate care unit is a viable option to alleviate the burden on hospitals by reducing acute secondary care admission volumes.
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Affiliation(s)
- Terje P. Hagen
- Department of Health Management and Health Economics, Institute of Health and Society, University of Oslo, PO Box 1089 Blindern, NO-0317 Oslo, Norway
| | - Trond Tjerbo
- Department of Health Management and Health Economics, Institute of Health and Society, University of Oslo, PO Box 1089 Blindern, NO-0317 Oslo, Norway
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Seamark DA, Prodger E, Jay T, Gibbard E, Tucker H. Response of UK community hospitals to the COVID-19 pandemic: an appreciative inquiry. BMJ Open Qual 2022; 11:bmjoq-2022-001958. [PMID: 36207053 PMCID: PMC9556737 DOI: 10.1136/bmjoq-2022-001958] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2022] [Accepted: 08/23/2022] [Indexed: 11/04/2022] Open
Abstract
INTRODUCTION The 500 community hospitals in the UK provide a range of services to their communities. The response of these small, mainly rural, hospitals to the COVID-19 pandemic has not yet been examined and so this study sought to address this gap. METHOD Appreciative inquiry was used to understand staff perspectives of how community hospitals responded to the COVID-19 (SARS-CoV-2) pandemic. A total of 20 organisations participated, representing 168 (34%) community hospitals in the UK. Qualitative interviews were conducted, with a total of 85 staff members, using an online video platform. 30 case studies were developed from these interviews. RESULTS Staff described positive changes that were made in the context of the fear and uncertainty experienced in the pandemic. Quality improvements were reported in a wide range of services and models of care such as the use of the inpatient beds, and the access and management of urgent care services. Rapid changes were made in the way that services were managed, such as communications and leadership. Programmes of accelerated training were offered for existing and redeployed staff. Attention to staff health and well-being was a feature and there were a variety of innovations designed to support patients and their families. The impact of the changes was viewed as strengthening of integrated working between staff and sectors, the ability to rapidly innovate and improve quality, and the scope to use local decision-making to make changes. CONCLUSION Staff of community hospitals described innovative and rapid quality improvements in their community hospitals in response to the pandemic. The case studies illustrated the features of community hospitals, showing that they can be resilient, flexible, responsive, creative, compassionate and integrated. The case studies of quality improvements are being used to encourage sharing and learning across community hospitals and beyond.
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Affiliation(s)
| | | | - Trish Jay
- Community Hospitals Association, Monmouth, UK
| | - Emma Gibbard
- Research and Innovations Services, University of Bath, Bath, UK
| | - Helen Tucker
- Health and Wellbeing Research Department, University of Winchester, Winchester, UK
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Saari H, Ryynänen OP, Lönnroos E, Kekolahti P, Mäntyselkä P, Kokko S. Factors Associated With Discharge Destination in Older Patients: Finnish Community Hospital Cohort Study. J Am Med Dir Assoc 2022; 23:1868.e1-1868.e8. [PMID: 35961413 DOI: 10.1016/j.jamda.2022.07.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2022] [Revised: 06/07/2022] [Accepted: 07/05/2022] [Indexed: 11/18/2022]
Abstract
OBJECTIVES Primary care physician-led community hospitals provide basic hospital care for older people in Finland. Yet little is known of the outcomes of the care. We investigated factors associated with discharge destination after hospitalization in a community hospital and the role of active rehabilitation during the stay. DESIGN Prospective observational study. SETTING AND PARTICIPANTS Short-term community hospital stays of older adults (≥65 years) living in the Kuopio University Hospital district in central and eastern Finland. METHODS Data on short-term (1-31 days) hospital stays from 51 community hospitals were collected with an electronic survey between January and June 2016. Physicians, secretaries, and rehabilitation staff from each community hospital completed the data collection form. Discharge destination was defined as home, residential care or death, and active rehabilitation as frequency of rehabilitation at least once a day. Analyses were conducted using the Bayesian approach and the BayesiaLab 9.1 tool. RESULTS Data of 11,628 community hospital stays were analyzed. The patients' mean age was 81.6 years (SD 7.9), and 57.5% were women. A younger age (65-74 years), a high number of rehabilitation staff (>2 per 10 patients), and receiving rehabilitation at least once a day were associated with discharging patients to their own homes. Daily rehabilitation was associated with returning to home in all patient groups. CONCLUSIONS AND IMPLICATIONS Older patients admitted to a community hospital for any reason may benefit from active rehabilitation. The role of community hospitals in the acute care and rehabilitation of older patients is important in aging societies.
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Affiliation(s)
- Henna Saari
- Institute of Public Health and Clinical Nutrition, University of Eastern Finland, Kuopio, Finland; Primary Health Care Unit, Kuopio University Hospital, Kuopio, Finland.
| | - Olli-Pekka Ryynänen
- Institute of Public Health and Clinical Nutrition, University of Eastern Finland, Kuopio, Finland; Primary Health Care Unit, Kuopio University Hospital, Kuopio, Finland
| | - Eija Lönnroos
- Institute of Public Health and Clinical Nutrition, University of Eastern Finland, Kuopio, Finland
| | - Pekka Kekolahti
- Aalto University, School of Electrical Engineering, Department of Communications and Networking, Espoo, Finland
| | - Pekka Mäntyselkä
- Institute of Public Health and Clinical Nutrition, University of Eastern Finland, Kuopio, Finland; Primary Health Care Unit, Kuopio University Hospital, Kuopio, Finland
| | - Simo Kokko
- Primary Health Care Unit, Kuopio University Hospital, Kuopio, Finland
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Hedman M, Boman K, Brännström M, Wennberg P. Clinical profile of rural community hospital inpatients in Sweden - a register study. Scand J Prim Health Care 2021; 39:92-100. [PMID: 33569976 PMCID: PMC7971215 DOI: 10.1080/02813432.2021.1882086] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Abstract
OBJECTIVE Patients in Sweden's rural community hospitals have not been clinically characterised. We compared characteristics of patients in general practitioner-led community hospitals in northern Sweden with those admitted to general hospitals. DESIGN Retrospective register study. SETTING Community and general hospitals in Västerbotten and Norrbotten counties, Sweden. PATIENTS Patients enrolled at community hospitals and hospitalised in community and general hospitals between 1 January 2010 and 31 December 2014. OUTCOME MEASURES Age, sex, number of admissions, main, secondary and total number of diagnoses. RESULTS We recorded 16,133 admissions to community hospitals and 60,704 admissions to general hospitals. Mean age was 76.8 and 61.2 years for community and general hospital patients (p < .001). Women were more likely than men to be admitted to a community hospital after age adjustment (odds ratio (OR): 1.11; 95% confidence interval (CI): 1.09-1.17). The most common diagnoses in community hospital were heart failure (6%) and pneumonia (5%). Patients with these diagnoses were more likely to be admitted to a community than a general hospital (OR: 2.36; 95% CI: 2.15-2.59; vs. OR: 3.32: 95% CI: 2.77-3.98, respectively, adjusted for age and sex). In both community and general hospitals, doctors assigned more diagnoses to men than to women (both p<.001). CONCLUSIONS Patients at community hospitals were predominantly older and women, while men were assigned more diagnoses. The most common diagnoses were heart failure and pneumonia. Our observed differences should be further explored to define the optimal care for patients in community and general hospitals.Key pointsThe patient characteristics at Swedish general practitioner-led rural community hospitals have not yet been reported. This study characterises inpatients in community hospitals compared to those referred to general hospitals.• Patients at community hospitals were predominantly older, with various medical conditions that would have led to a referral to general hospitals elsewhere in Sweden. • Compared to men, women were more likely to be admitted to community hospitals than to general hospitals, even after adjustment for age. To the best of our knowledge, this pattern has not been reported in other countries with community hospitals. • In both community hospitals and general hospitals, doctors assigned more diagnoses to men than to women.
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Affiliation(s)
- Mante Hedman
- Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden
- CONTACT Mante Hedman Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden
| | - Kurt Boman
- Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden
| | | | - Patrik Wennberg
- Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden
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Seamark D, Davidson D, Ellis-Paine A, Glasby J, Tucker H. Factors affecting the changing role of GP clinicians in community hospitals: a qualitative interview study in England. Br J Gen Pract 2019; 69:e329-e335. [PMID: 30803983 PMCID: PMC6478466 DOI: 10.3399/bjgp19x701345] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2018] [Accepted: 10/10/2018] [Indexed: 10/31/2022] Open
Abstract
BACKGROUND GPs were a key driving force for the development of a network of community hospitals across England, and have provided medical cover for most of them. However, during the past decade there has been a significant shift, with the dominant trend appearing to be one of declining GP involvement. AIM To explore how and why the role of GPs within community hospitals in England is changing. DESIGN AND SETTING Qualitative study in a sample of nine diverse community hospitals in England. METHOD Qualitative interviews with community hospital clinical staff. RESULTS In all, 20 interviews were conducted and two models of medical care observed: GPs employed by a practice and trust-employed doctors. Interviewees confirmed the trend towards declining GP involvement, with the factors driving change identified as being GP workload and recruitment challenges, a change from 'step-up' admissions from the community to 'step-down' admissions from acute hospitals, fewer local patients being admitted, increased medical acuity of patients admitted, increased burden of medical support required, and inadequate remuneration. The majority of doctors viewed community hospital work in a positive light, welcoming the opportunities for personal development and to acquire new clinical skills. GPs viewed community hospital work as an extension of primary care, adding to job satisfaction. CONCLUSION Multiple factors have driven changes in the role of GP community hospital clinicians. The NHS needs to develop a focused strategy if GPs are to remain engaged with community hospital work.
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Davidson D, Ellis Paine A, Glasby J, Williams I, Tucker H, Crilly T, Crilly J, Mesurier NL, Mohan J, Kamerade D, Seamark D, Marriott J. Analysis of the profile, characteristics, patient experience and community value of community hospitals: a multimethod study. HEALTH SERVICES AND DELIVERY RESEARCH 2019. [DOI: 10.3310/hsdr07010] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
BackgroundCommunity hospitals have been part of England’s health-care landscape since the mid-nineteenth century. Evidence on them has not kept pace with their development.AimTo provide a comprehensive analysis of the profile, characteristics, patient experience and community value of community hospitals.DesignA multimethod study with three phases. Phase 1 involved national mapping and the construction of a new database of community hospitals through data set reconciliation and verification. Phase 2 involved nine case studies, including interviews and focus groups with patients (n = 60), carers (n = 28), staff (n = 132), volunteers (n = 68), community stakeholders (n = 74) and managers and commissioners (n = 9). Phase 3 involved analysis of Charity Commission data on voluntary support.SettingCommunity hospitals in England.ResultsThe study identified 296 community hospitals with beds in England. Typically, the hospitals were small (< 30 beds), in rural communities, led by doctors/general practitioners (GPs) and nurses, without 24/7 on-site medical cover and provided step-down and step-up inpatient care, with an average length of stay of < 30 days and a variable range of intermediate care services. Key to patients’ and carers’ experiences of community hospitals was their closeness to ‘home’ through their physical location, environment and atmosphere and the relationships that they support; their provision of personalised, holistic care; and their role in supporting patients through difficult psychological transitions. Communities engage with and support their hospitals through giving time (average 24 volunteers), raising money (median voluntary income £15,632), providing services (voluntary and community groups) and giving voice (e.g. taking part in communication and consultation). This can contribute to hospital utilisation and sustainability, patient experience, staff morale and volunteer well-being. Engagement varies between and within communities and over time. Community hospitals are important community assets, representing direct and indirect value: instrumental (e.g. health care), economic (e.g. employment), human (e.g. skills development), social (e.g. networks), cultural (e.g. identity and belonging) and symbolic (e.g. vitality and security). Value varies depending on place and time.LimitationsThere were limitations to the secondary data available for mapping community hospitals and tracking charitable funds and to the sample of case study respondents, which concentrated on people with a connection to the hospitals.ConclusionsCommunity hospitals are diverse but are united by a set of common characteristics. Patients and carers experience community hospitals as qualitatively different from other settings. Their accounts highlight the importance of considering the functional, interpersonal, social and psychological dimensions of experience. Community hospitals are highly valued by their local communities, as demonstrated through their active involvement as volunteers and donors. Community hospitals enable the provision of local intermediate care services, delivered through an embedded, relational model of care, which generates deep feelings of reassurance. However, current developments may undermine this, including the withdrawal of GPs, shifts towards step-down care for non-local patients and changing configurations of services, providers and ownership.Future workComparative studies of patient experience in different settings; longitudinal studies of community support and value; studies into the implications of changes in community hospital function, GP involvement, provider-mix and ownership; and international comparative studies could all be undertaken.FundingThe National Institute for Health Research Health Services and Delivery Research programme.
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Affiliation(s)
- Deborah Davidson
- School of Social Policy, University of Birmingham, Birmingham, UK
| | | | - Jon Glasby
- School of Social Policy, University of Birmingham, Birmingham, UK
| | - Iestyn Williams
- School of Social Policy, University of Birmingham, Birmingham, UK
| | - Helen Tucker
- Helen Tucker Associates Ltd, Newport, Shropshire, UK
| | | | | | - Nick Le Mesurier
- School of Social Policy, University of Birmingham, Birmingham, UK
| | - John Mohan
- School of Social Policy, University of Birmingham, Birmingham, UK
| | - Daiga Kamerade
- School of Health and Society, University of Salford, Salford, UK
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Williams KS, Kurtev S, Phelps K, Regen E, Conroy S, Wilson A. Shifting care from community hospitals to intensive community support: a mixed method study. Prim Health Care Res Dev 2018; 19:53-63. [PMID: 28899447 PMCID: PMC6452972 DOI: 10.1017/s1463423617000603] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2016] [Revised: 03/22/2017] [Accepted: 08/17/2017] [Indexed: 11/07/2022] Open
Abstract
Aim To examine how the introduction of intensive community support (ICS) affected admissions to community hospital (CH) and to explore the views of patients, carers and health professionals on this transition. BACKGROUND ICS was introduced to provide an alternative to CH provision for patients (mostly very elderly) requiring general rehabilitation. METHOD Routine data from both services were analysed to identify the number of admissions and length of stay between September 2012 and September 2014. In total, 10 patients took part in qualitative interviews. Qualitative interviews and focus groups were undertaken with 19 staff members, including managers and clinicians. Findings There were 5653 admissions to CH and 1710 to ICS between September 2012 and September 2014. In the five months before the introduction of ICS, admission rates to CH were on average 217/month; in the final five months of the study, when both services were fully operational, average numbers of patients admitted were: CH 162 (a 25% reduction), ICS 97, total 259 (a 19% increase). Patients and carers rated both ICS and CH favourably compared with acute hospital care. Those who had experienced both services felt each to be appropriate at the time; they appreciated the 24 h availability of staff in CH when they were more dependent, and the convenience of being at home after they had improved. In general, staff welcomed the introduction of ICS and appreciated the advantages of home-based rehabilitation. Managers had a clearer vision of ICS than staff on the ground, some of whom felt underprepared to work in the community. There was a consensus that ICS was managing less complex and dependent patients than had been envisaged. CONCLUSION ICS can provide a feasible adjunct to CH that is acceptable to patients. More work is needed to promote the vision of ICS amongst staff in both community and acute sectors.
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Affiliation(s)
- Kate S. Williams
- Senior Research Fellow in Nursing, Department of Health Sciences, University of Leicester, Leicester, UK
| | - Stoyan Kurtev
- Information Analyst, Department of Health Sciences, University of Leicester, Leicester, UK
| | - Kay Phelps
- Research Fellow, Department of Health Sciences, University of Leicester, Leicester, UK
| | - Emma Regen
- Research Fellow, Department of Health Sciences, University of Leicester, Leicester, UK
| | - Simon Conroy
- Professor of Geriatric Medicine, Department of Health Sciences, University of Leicester, Leicester, UK
| | - Andrew Wilson
- Professor of Primary Care Research, Department of Health Sciences, University of Leicester, Leicester, UK
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Winpenny EM, Corbett J, Miani C, King S, Pitchforth E, Ling T, van Teijlingen E, Nolte E. Community Hospitals in Selected High Income Countries: A Scoping Review of Approaches and Models. Int J Integr Care 2016; 16:13. [PMID: 28316553 PMCID: PMC5354221 DOI: 10.5334/ijic.2463] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2016] [Accepted: 10/24/2016] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND There is no single definition of a community hospital in the UK, despite its long history. We sought to understand the nature and scope of service provision in community hospitals, within the UK and other high-income countries. METHODS We undertook a scoping review of literature on community hospitals published from 2005 to 2014. Data were extracted on features of the hospital model and the services provided, with results presented as a narrative synthesis. RESULTS 75 studies were included from ten countries. Community hospitals provide a wide range of services, with wide diversity of provision appearing to reflect local needs. Community hospitals are staffed by a mixture of general practitioners (GPs), nurses, allied health professionals and healthcare assistants. We found many examples of collaborative working arrangements between community hospitals and other health care organisations, including colocation of services, shared workforce with primary care and close collaboration with acute specialists. CONCLUSIONS Community hospitals are able to provide a diverse range of services, responding to geographical and health system contexts. Their collaborative nature may be particularly important in the design of future models of care delivery, where emphasis is placed on integration of care with a key focus on patient-centred care.
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Affiliation(s)
- Eleanor M. Winpenny
- RAND Europe, Westbrook Centre, Milton Road, Cambridge, CB4 1YG, United Kingdom
| | - Jennie Corbett
- RAND Europe, Westbrook Centre, Milton Road, Cambridge, CB4 1YG, United Kingdom
| | - Celine Miani
- RAND Europe, Westbrook Centre, Milton Road, Cambridge, CB4 1YG, United Kingdom
| | - Sarah King
- RAND Europe, Westbrook Centre, Milton Road, Cambridge, CB4 1YG, United Kingdom
| | - Emma Pitchforth
- RAND Europe, Westbrook Centre, Milton Road, Cambridge, CB4 1YG, United Kingdom
| | - Tom Ling
- RAND Europe, Westbrook Centre, Milton Road, Cambridge, CB4 1YG, United Kingdom
| | - Edwin van Teijlingen
- Bournemouth House B112c, 19 Christchurch Road, Bournemouth, BH1 3LH, United Kingdom
| | - Ellen Nolte
- London School of Economics and Political Science, Houghton Street, London WC2A 2AE, United Kingdom
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Lappegard Ø, Hjortdahl P. Acute admissions to a community hospital: experiences from Hallingdal sjukestugu. Scand J Public Health 2012; 40:309-15. [PMID: 22786914 DOI: 10.1177/1403494812450372] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
AIMS Acute admissions to anywhere other than general hospitals are uncommon in Norway, but at Hallingdal sjukestugu, a community hospital in a rural district, this has been practiced for years. This article presents experiences from this practice. Materials and METHODS Hallingdal sjukestugu is a decentralized, specialist healthcare service, under the administration and funding of Ringerike sykehus, the nearest general hospital, which is 170 km away. General practitioners under telephone supervision of the hospital specialists run the inpatient department. Six municipalities with 20,000 inhabitants make use of the community hospital. Statistics were obtained from the patient administration systems and from manual statistics continuously registered in 2009-10. RESULTS In 2009-10 the inpatient department, an intermediate care unit with 14 beds, had an average of 605 admissions a year, with a mean length of stay of 6.3 days. There were 455 acute admissions to Hallingdal sjukestugu. Forty per cent of these patients were younger than 67 and 36% were older than 80 years of age. Half were admitted for observation and half for treatment. The main diagnostic groups were infections, injuries and palliative care. Seventeen per cent of the acute admitted patients were later transferred to the general hospital for further work-up or treatment; 70% were discharged to their homes. CONCLUSIONS The experiences from Hallingdal sjukestugu indicate that it is feasible to give a selected group of patients an alternative to acute admissions to a general hospital.
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Affiliation(s)
- Øystein Lappegard
- Department of Hallingdal sjukestugu, Medical Clinic of Ringerike General Hospital, Vestre Viken Hospital Trust, Norway and Hallingforsk, Ål Municipality, Ål, Norway.
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Abstract
Community hospitals provide many services for older people. They are mainly managed by nursing staff, with some specialist input. Little is known about education provided in these facilities. Most education in geriatric medicine is provided in hospitals, despite most elderly care being provided in the community. The authors surveyed senior nursing staff in Irish community hospitals to examine this area in more detail. Staff in all 18hospitals in the Health Service Executive (South) area were invited to participate. The response rate was 100%. Sixteen of the 18 respondents (89%) felt staff did not have enough education in geriatric medicine. Just over half of hospitals had regular staff education sessions in the area, with a minority of sessions led by a geriatrician, and none by GPs. Geriatrician visits were valued, but were requested only every 1-3 months. Staff identified challenging behaviour and dementia care as the areas that posed most difficulty.
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