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Results for 'costs'

Results 1 - 10 of 28

Never too late: prevention in an ageing world


This report explores how health care systems can better prevent ill health across people's lives, focusing on people interventions among those aged 50 and over. It presents analysis focussing on a small number of diseases where preventative interventions by healthcare systems could make a real difference to people’s health and wellbeing. These are cardiovascular, lung cancer, type 2 diabetes and HIV. It also considers the case of flu. It presents a snapshot of the potential burden and cost of these diseases, such as costs due to sick days, presenteeism and early retirement. It also provides brief overviews of preventative interventions, which have the potential to help people live healthier for longer. The analysis presented in the report shows that failure to invest in prevention will bring substantial social, health and economic costs. It argues that in order to follow through on commitments to prevention, governments need to improve access to preventative interventions to tackle growing health inequalities; encourage populations, professionals and policymakers to promote good health and prevent illness; and effectively utilise technology to deliver preventative interventions.

Effects of participating in community assets on quality of life and costs of care: longitudinal cohort study of older people in England

MUNFORD Luke Aaron, et al

Objectives: Improving outcomes for older people with long-term conditions and multimorbidity is a priority. Current policy commits to substantial expansion of social prescribing to community assets, such as charity, voluntary or community groups. This study uses longitudinal data to add to the limited evidence on whether this is associated with better quality of life or lower costs of care. Design: Prospective 18-month cohort survey of self-reported participation in community assets and quality of life linked to administrative care records. Effects of starting and stopping participation estimated using double-robust estimation. Setting: Participation in community asset facilities. Costs of primary and secondary care. Participants 4377 older people with long-term conditions. Intervention Participation in community assets. Primary and secondary outcome measures Quality-adjusted life years (QALYs), healthcare costs and social value estimated using net benefits. Results: Starting to participate in community assets was associated with a 0.017 (95% CI 0.002 to 0.032) gain in QALYs after 6 months, 0.030 (95% CI 0.005 to 0.054) after 12 months and 0.056 (95% CI 0.017 to 0.094) after 18 months. Cumulative effects on care costs were negative in each time period: £−96 (95% CI £−512 to £321) at 6 months; £−283 (95% CI £−926 to £359) at 12 months; and £−453 (95% CI £−1366 to £461) at 18 months. The net benefit of starting to participate was £1956 (95% CI £209 to £3703) per participant at 18 months. Stopping participation was associated with larger negative impacts of −0.102 (95% CI −0.173 to −0.031) QALYs and £1335.33 (95% CI £112.85 to £2557.81) higher costs after 18 months. Conclusions: Participation in community assets by older people with long-term conditions is associated with improved quality of life and reduced costs of care. Sustaining that participation is important because there are considerable health changes associated with stopping. The results support the inclusion of community assets as part of an integrated care model for older patients.

Reducing emergency hospital admissions: a population health complex intervention of an enhanced model of primary care and compassionate communities

ABEL Julian, et al

Background: Reducing emergency admissions to hospital has been a cornerstone of healthcare policy. Little evidence exists to show that systematic interventions across a population have achieved this aim. The authors report the impact of a complex intervention over a 44-month period in Frome, Somerset, on unplanned admissions to hospital. Aim: To evaluate a population health complex intervention of an enhanced model of primary care and compassionate communities on population health improvement and reduction of emergency admissions to hospital. Design and setting: A cohort retrospective study of a complex intervention on all emergency admissions in Frome Medical Practice, Somerset, compared with the remainder of Somerset, from April 2013 to December 2017. Method: Patients were identified using broad criteria, including anyone giving cause for concern. Patient-centred goal setting and care planning combined with a compassionate community social approach was implemented broadly across the population of Frome. Results: There was a progressive reduction, by 7.9 cases per quarter (95% confidence interval [CI] = 2.8 to 13.1, P = 0.006), in unplanned hospital admissions across the whole population of Frome during the study period from April 2013 to December 2017, a decrease of 14.0%. At the same time, there was a 28.5% increase in admissions per quarter within Somerset, with a rise in the number of unplanned admissions of 236 per quarter (95% CI = 152 to 320, P<0.001). Conclusion The complex intervention in Frome was associated with highly significant reductions in unplanned admissions to hospital, with a decrease in healthcare costs across the whole population of Frome.

Cost-effectiveness of telecare for people with social care needs: the Whole Systems Demonstrator cluster randomised trial

HENDERSON Catherine, et al

Purpose of the study: to examine the costs and cost-effectiveness of ‘second-generation’ telecare, in addition to standard support and care that could include ‘first-generation’ forms of telecare, compared with standard support and care that could include ‘first-generation’ forms of telecare. Design and methods: a pragmatic cluster-randomised controlled trial with nested economic evaluation. A total of 2,600 people with social care needs participated in a trial of community-based telecare in three English local authority areas. In the Whole Systems Demonstrator Telecare Questionnaire Study, 550 participants were randomised to intervention and 639 to control. Participants who were offered the telecare intervention received a package of equipment and monitoring services for 12 months, additional to their standard health and social care services. The control group received usual health and social care. Primary outcome measure: incremental cost per quality-adjusted life year (QALY) gained. The analyses took a health and social care perspective. Results: cost per additional QALY was £297,000. Cost-effectiveness acceptability curves indicated that the probability of cost-effectiveness at a willingness-to-pay of £30,000 per QALY gained was only 16%. Sensitivity analyses combining variations in equipment price and support cost parameters yielded a cost-effectiveness ratio of £161,000 per QALY. Implications: while QALY gain in the intervention group was similar to that for controls, social and health services costs were higher. Second-generation telecare did not appear to be a cost-effective addition to usual care, assuming a commonly accepted willingness to pay for QALYs.

Prevention: wrestling with new economic realities

KNAPP Martin

Purpose : The purpose of this paper is to discuss the economic pressures on long-term care systems, and describe how an economic case might be made for better care, support and preventive strategies. Design/methodology/approach: Discussion of recent developments and research responses, with illustrations from previous studies. Findings: Economics evidence is highly relevant to decision makers in health, social care, and related systems. When resources are especially tight, economics evidence can sometimes persuade uncertain commissioners and others to adopt courses of action that improve the wellbeing of individuals, families, and communities. Originality/value: The paper uses long-established approaches in economic evaluation to discuss preventive and other strategies in today's challenging context.

Harnessing technology to tackle loneliness

WPI ECONOMICS, OAKLEY Matthew, ROSE Christina Bovill

This report, commissioned by Vodafone and produced by WPI Economics, looks at the prevalence of loneliness in the UK and role technology can play in alleviating loneliness in older people by keeping them connected to their family and friends for longer. Focusing on chronic loneliness amongst people aged over 50, the report also provides new estimates of the potential scale of costs associated with loneliness, which it estimates as £1.8 billion per year to the UK economy. It highlights how technology can be used alongside more traditional community services to facilitate social interaction, and that learning how to use it more fully can reduce loneliness and promote an active lifestyle. This can help older people remain independent in their homes and communities and increase confidence and the likelihood of positive interactions. It can also help to maintain and build networks and contacts, with technology used as a way of keeping in touch with friends and family and accessing new communities and groups. The report outlines five recommendations to promote the use of technology in tackling loneliness, which over improving access to technology, increasing confidence and skills in the use of technology and supporting innovative technological solutions.

Age UK Rotherham hospital aftercare service: evaluation of the pilot extension into UECC and AMU at TRFT


An independent evaluation of the pilot extension of the Age UK Rotherham (AUKR) Hospital Aftercare Service (HAS, into the Emergency Department and Assessment Medical Unit of The Rotherham Foundation Trust Hospital. The pilot, funded by the Clinical Commissioning Group (CCG), ran from 1st October 2017 to 30th September 2018. The evaluation looks at outcomes, focussing on the impact of the service on avoidable hospital admissions, patient experience and independence. It reports that the pilot service provided support to 239 older people who would otherwise have been admitted, offering transport to return home where safe to do so, help and support to settle back in at home and support to access other forms of community based support to enable them to continue to live independently. The findings of the evaluation were overwhelmingly positive. Outcomes achieved include: the prevention of 20 in-patient admissions resulting in the avoidance of £32,180 (estimated) in NHS costs; the provision of additional support in their home to 55 HAS patients and access additional benefits entitlements with a total value of £22,243.55; and reduced waiting times for patient prior to discharge and an improved flow through UECC. Both patients and staff were very positive about the service. The evaluation estimates that overall the pilot led to total benefits (to health services and to patients) of £65,704, a return on investment of 73 pence (£0.73) for each pound (£) invested by the CCG.

Disabled Facilities Grant (DFG) and other adaptations: external review

MACKINTOSH Shelia, et al

This review, commissioned by the Department of Health and Social Care, looks at how the Disabled Facilities Grant (DFG) currently operates and makes evidence based recommendations for how it should change in the future. It review aims to develop more effective ways of supporting more people to live in suitable housing so they can stay independent for longer and makes the case for more joint working across housing, health and social care. The focus of the review is on how the disabled or older person can be put at the centre of service provision and what would make it easier for them to access services. It also looks at the role of DFG in prevention and how it can deliver this more effectively. It draws on a range of evidence, including: analysis of data from LOGASnet returns; consultation events attended by local authorities and home improvement agencies; interviews with staff from selected local authorities; and a short review of the academic, policy and practice literature. The conclusions and recommendations include: renaming the grant to reflect that it is part of a broader set interventions to help people remain independent; improved integration of services; better partnership working between health and care and different professions; raising the upper limit of the grant; and changes to the current formula for allocating funding; and updating of the existing means testing regulations. The review also identifies additional research to be carried out.

Economic evaluations of falls prevention programs for older adults: a systematic review

OLIJ Branko F., et al

Objectives: To provide a comprehensive overview of economic evaluations of falls prevention programs and to evaluate the methodology and quality of these studies. Design: Systematic review of economic evaluations on falls prevention programs. Setting: Studies (N=31) of community‐dwelling older adults (n=25), of older adults living in residential care facilities (n=3), and of both populations (n=3) published before May 2017. Participants: Adults aged 60 and older. Measurements: Information on study characteristics and health economics was collected. Study quality was appraised using the 20‐item Consensus on Health Economic Criteria. Results: Economic evaluations of falls prevention through exercise (n = 9), home assessment (n = 6), medication adjustment (n = 4), multifactorial programs (n = 11), and various other programs (n = 13) were identified. Approximately two‐thirds of all reported incremental cost‐effectiveness ratios (ICERs) with quality‐adjusted life‐years (QALYs) as outcome were below the willingness‐to‐pay threshold of $50,000 per QALY. All studies on home assessment and medication adjustment programs reported favorable ICERs, whereas the results of studies on exercise and multifactorial programs were inconsistent. The overall methodological quality of the studies was good, although there was variation between studies. Conclusion: The majority of the reported ICERs indicated that falls prevention programs were cost‐effective, but methodological differences between studies hampered direct comparison of the cost‐effectiveness of program types. The results imply that investing in falls prevention programs for adults aged 60 and older is cost‐effective. Home assessment programs (ICERs < $40,000/QALY) were the most cost‐effective type of program for community‐dwelling older adults, and medication adjustment programs (ICERs < $13,000/QALY) were the most cost‐effective type of program for older adults living in a residential care facility.

Evaluation of the Homeshare pilots: final report


The final evaluation report of Homeshare pilots programme (HSP), which looks at what works to develop a sustainable Homeshare scheme. Homeshare schemes bring together older people who need support to stay in their homes, with young people who provide companionship and low level support in return for an affordable place to live. The evaluation, commissioned by SCIE and conducted by Traverse, identifies which approaches and activities work best, barriers to successful schemes, cost and benefits, and identifies factors that to be used by commissioners to assess bids for Homeshare schemes. It draws on qualitative interviews with pilot leads and staff, local authority stakeholders, referral agencies and with householders and homesharers from the first matches achieved in three HSP sites. It covers experiences of living in a Homeshare, operating a sustainable Homeshare scheme, referral and sustainability, and highlights broader learning for the social care and housing sectors. The results show how that Homeshare can reduce loneliness and improve wellbeing by offering companionship and facilitating inter-generational relationships, as well as addressing the lack of affordable housing options. The report concludes that the programme has been successful in supporting the development of Homeshare sites and provided learning in what works in supporting innovation within delivery of social and housing support.

Results 1 - 10 of 28


Moving Memory

Moving Memory Practice example about how the Moving Memory Dance Theatre Company is challenging perceived notions of age and ageing.

Chatty Cafe Scheme

Chatty Cafe Scheme Practice example about how the Chatty Cafe Scheme is helping to tackle loneliness by bringing people of all ages together

Oomph! Wellness

Oomph! Wellness Practice example about how Oomph! Wellness is supporting staff to get older adults active and combat growing levels of social isolation


KOMP Practice example about how KOMP, designed by No Isolation is helping older people stay connected with their families

LAUGH research project

LAUGH research project Practice example about a research project to develop highly personalised, playful objects for people with advanced dementia
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