Results for 'hospital admission'
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GEORGHIOU Theo, et al
Presents the findings of an evaluation of seven social action projects funded by the Cabinet Office, NHS England, Monitor, NHS Trust Development Authority and the Association of Directors of Adult Social Services. The aim of the Reducing Winter Pressures Fund was to scale up and test projects that used volunteers to support older people to stay well, manage health conditions or recover after illness, and thereby reduce pressure on hospitals. The organisations supported by the fund comprised a range of national and local charities. These projects fell into three broad categories: community-based support, supporting discharge from hospital wards, and supporting individuals in A&E department to avoid admissions. Between them, the projects offered a wide range of services to older people – both direct (for example help with shopping or providing transport) and indirect (linking with other services). The evaluation resulted in a mixed set of findings. From the interviews with staff, volunteers and local stakeholders, there was evidence of services that had made an impact by providing practical help, reassurance and connection with other services that could reduce isolation and enable independence. Those involved with the projects felt that volunteers and project staff could offer more time to users than pressurised statutory sector staff, which enabled a fuller understanding of a person’s needs while also freeing up staff time. However, the analysis of hospital activity data in the months that followed people's referral into the projects did not suggest that these schemes impacted on the use of NHS services in the way that was assumed, with no evidence of a reduction in emergency hospital admissions, or in costs of hospital care following referral to the social action projects. The one exception was the project based in an A&E department, which revealed a smaller number of admissions in the short term. The report questions whether these sorts of interventions can ever be fully captured solely using hospital-based data and conceptualising reduced or shortened admissions as a key marker of success.
DAYSON Chris, BASHIR Nadia
Provides a detailed assessment of the social and economic impact of the Rotherham Social Prescribing Pilot from the perspective of key stakeholders. Social prescribing provides a way of linking patients in primary care and their carers with nonmedical sources of support within the community. Over the course of the pilot: 24 voluntary and community organisations (VCOs) received grants with a total value of just over £600,000 to deliver a menu of 31 separate social prescribing services; 1,607 patients were referred to the service, of whom 1,118 were referred on to funded VCS services; the five most common types of funded services referred to were information and advice, community activity, physical activities, befriending and enabling. The evaluation looked at the impact on the demand for hospital care and the economic and social benefits. The findings demonstrate that economic and social outcomes have been created for three main stakeholder groups: patients with LTCs and their carers, who have experienced improved mental health and greater engagement with the community; the local public sector, in particular health bodies, which have benefited from the reduced use of hospital resources; and the local voluntary and community sector, which has benefited from a catalytic investment in community level service provision.
COMMISSION ON IMPROVING URGENT CARE FOR OLDER PEOPLE
Final report from the Commission on Improving Urgent Care for Older People which provides guidance for those involved in designing care for older people and outlines eight key principles the health and care sector can adopt to improve urgent care for older people. The Commission was established out of a concern that the care system was not meeting the needs of older people, resulting in lower quality of care, a lack of out-of-hospital services as an alternative to A&E, not enough focus on prevention and early intervention, and delayed transfers of care. It brought together a range of experts, received over 60 evidence submissions; carried out visits to sites using innovative ways to deliver care; consulted with NHS Confederation members and patient and carer groups; and commissioned an evidence review. The report draws on the evidence to look at the case for change. It then outlines eight key principles that can be used when redesigning health and social care system: start with care driven by the person’s needs and personal goals; a greater focus on proactive care; acknowledge current strains on the system and allow time to think; the importance of care co-ordination and navigation; greater use of multi-disciplinary and multi-agency teams; ensure workforce, training and core skills reflect modern day requirements; leadership should encourage us to do things differently; and metrics must truly reflect the care experience for older people. Short case studies of innovative practice are included in the report, covering acute and primary care, voluntary sector and local government partners and commissioners.
This report sets out key steps that commissioners can take in collaboration with service providers to enable people who are approaching the end of life to avoid being admitted to hospital when this is possible and appropriate, as well as enabling those who are admitted to make a transition to a community setting quickly. The report argues that as well as reducing the costs to the NHS, enabling people to stay out of hospital at the end of life can make a significant difference to the experiences of dying people and their families. The report makes a number of recommendations for commissioners, service providers and health and social care staff, including: commissioning the increased provision of 24/7 care in community settings, through care homes and hospices, and community health and social care services that can provide care in people’s homes; commissioning anticipatory prescribing of medicines for people approaching the end of life; using available funding, through System Resilience Groups, the Better Care Fund, and Integrated Personal Commissioning, to improve co-ordination between hospitals and community settings, including hospices, for people approaching the end of life; and health and social care staff identifying carers of people who are approaching the end of life and referring them for local authority assessments.
WATSON Pat, SHUCKSMITH Janet
The Community Agents Project, a programme jointly funded through health and adult social care services, is an innovative approach to meeting the social needs of the elderly and vulnerable population. Community agents act as a one-stop shop, signposting people to the appropriate service that meets their needs. This could be an organisation or voluntary group that can help with shopping, arrange transport to the GP surgery or hospital appointments, help to complete forms, offer encouragement to maintain a care plan, organise a befriender, accompany to a local social activity or signposting to other agencies. The project has received a total of 486 referrals across the borough of Redcar & Cleveland for the period September 2014-September 2015, generating positive outcomes in the following areas: maintaining independence; faster discharge from hospital; reducing admissions to hospital; reducing isolation; improved financial status; appropriate use of health and social services; cost saving; and increases in community capacity. The report estimates a social return on investment of £3.29 for every £1 invested in the Community Agents Project.
BARDSLEY Martin, et al
Over the last five years the Nuffield Trust has undertaken evaluations of over 30 different community-based interventions. In many cases the authors have been tasked with identifying whether service changes have led to a reduction in emergency admissions and the associated cost to the NHS. Using these indicators, the results have been almost overwhelmingly negative. The one exception was Marie Curie Nursing Services for terminally ill patients. In this paper the authors outline the main community-based interventions they have evaluated and their impact, and identify nine points that may help those designing, implementing and evaluating such interventions in future. The paper could provide useful learning for the new health and social care integration ‘pioneer’ sites that will be appointed by the Department of Health by September 2013.
PATON Fiona, WILSON Paul, WRIGHT Kath
A synthesis of evidence assessing the predictive ability of tools used to identify frail elderly and people living with multiple long-term chronic health conditions who are at risk of future unplanned hospital admissions. There are now a large number of models available that can be used to predict the risk of unplanned hospital admissions and this study aims to provide a summary of their comparative performance. Overall, the models identified in this review show reasonable concordance in terms of their predictive performance (based on c-statistics). Models reporting other performance indications showed that at different thresholds, as sensitivity increased, specificity would decrease. As the algorithms become more complex or incorporate longer term horizons specificity increased but the ability of the models to identify future high cost individuals reduced. It should also be noted that whilst the reported c-statistics are broadly similar, the underlying populations, data sources and coding may differ.
DOUGHTY Kevin, MULVIHILL Patrick
Purpose: The purpose of this paper is to consider the importance of digital healthcare through telecare and portable assistive devices in supporting the reengineering of healthcare to deal with the needs of an older and more vulnerable population wishing to remain in their own homes.
Design/methodology/approach: It supports the importance of the assessment process to identify hazards associated with independent living, and the possible consequences of accidents. By measuring and prioritising the risks, appropriate management strategies may be introduced to provide a safer home environment.
Findings: A process for assessing and managing these risks has been developed. This can be applied to a wide range of different cases and yields solutions that can support independence.
Research limitations/implications: The developed digital reablement process can be used to provide vulnerable people with a robust form of risk management.
Practical implications: If telecare services follow the process described in this paper then they will improve the outcomes for their users.
Originality/value: The process described in this paper is the first attempt to produce a robust assessment process for introducing telecare services in a reablement context.
Older people represent the main in-patient group, at any one time occupying more than two-thirds of acute hospital in-patient beds. Providers and commissioners need to put in place cost-effective, community based services, which can both prevent the need for hospital admission and safely reduce length of stay for older people. A hospital admission can occur when an older person has reached breaking point because of a combination of problems that have been building up before admission: social circumstances (such as living alone or having caring responsibilities) or general frailty. The aim of this publication is to disseminate examples of positive practice in avoiding hospital admission, supporting safe discharge and preventing readmission for older people. This publication highlights 5 examples of local Age UK services, charting the ‘pathway’ of prevention from identifying older people in the local community who may be at risk, to supporting people who are in A&E, and ensuring that discharge from in-patient care is safe and well co-ordinated.
MAYO-WILSON Evan, et al
Background: Home visits for older adults aim to prevent cognitive and functional impairment, thus reducing institutionalisation and mortality. Visitors may provide information, investigate untreated problems, encourage medication compliance, and provide referrals to services.
Methods and Findings: Data Sources: Ten databases including CENTRAL and Medline searched through December 2012. Study Selection: Randomised controlled trials enrolling community-dwelling persons without dementia aged over 65 years. Interventions included visits at home by a health or social care professional that were not related to hospital discharge. Two authors independently extracted data. Outcomes were pooled using random effects. Main Outcomes and Measures used were mortality, institutionalisation, hospitalisation, falls, injuries, physical functioning, cognitive functioning, quality of life, and psychiatric illness.
Results: Sixty-four studies with 28642 participants were included. Home visits were not associated with absolute reductions in mortality at longest follow-up, but some programmes may have small relative effects. There was moderate quality evidence of no overall effect on the number of people institutionalised. There was high quality evidence for number of people who fell, which is consistent with no effect or a small effect, but there was no evidence that these interventions increased independent living. There was low and very low quality evidence of effects for quality of life and physical functioning respectively, but these may not be clinically important.
Conclusions: Home visiting is not consistently associated with differences in mortality or independent living, and investigations of heterogeneity did not identify any programmes that are associated with consistent benefits. Due to poor reporting of intervention components and delivery, the authors cannot exclude the possibility that some programmes may be effective.
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