ORCID

Abstract

Background: NHS England’s ‘Enhanced Health in Care Homes’ specification aims to make the healthcare of care home residents more proactive. Primary care networks (PCNs) are contracted to provide this, but approaches vary widely: challenges include frailty identification, multidisciplinary team (MDT) capability/capacity and how the process is structured and delivered.Aim: To determine whether a proactive healthcare model could improve healthcare outcomes for care home residents.Design and setting: Quality improvement project involving 429 residents in 40 care homes in a non-randomised crossover cohort design. The headline outcome was 2-year survival.Method: All care home residents had healthcare coordinated by the PCN’s Older Peoples’ Hub. A daily MDT managed the urgent healthcare needs of residents. Proactive healthcare, comprising information technology-assisted comprehensive geriatric assessment (i-CGA) and advanced care planning (ACP), were completed by residents, with prioritisation based on clinical needs.Time-dependent Cox regression analysis was used with patients divided into two groups: Control group: received routine and urgent (reactive) care only. Intervention group: additional proactive i-CGA and ACP.Results: By 2 years, control group survival was 8.6% (n=108), compared with 48.1% in the intervention group (n=321), p<0.001. This represented a 39.6% absolute risk reduction in mortality, 70.2% relative risk reduction and the number needed to treat of 2.5, with little changes when adjusting for confounding variables.Conclusion: A PCN with an MDT-hub offering additional proactive care (with an i-CGA and ACP) in addition to routine and urgent/reactive care may improve the 2-year survival in older people compared with urgent/reactive care alone.

Publication Date

2024-06-04

Publication Title

BMJ Open Quality

Volume

13

Issue

2

Acceptance Date

2024-05-10

Deposit Date

2024-06-28

Funding

Adam Gordon is an NIHR Senior Investigator and is part funded by the NIHR Applied Research Collaboration East Midlands (ARC-EM). Stuart Spicer was funded and supported by the National Institute for Health Research Applied Research Collaboration South West Peninsula (NIHR PenARC). Suzy Hope was supported by the National Institute for Health and Care Research Exeter Biomedical Research Centre and National Institute for Health and Care Research Exeter Clinical Research Facility. The views expressed are those of the authors and not necessarily those of the NIHR or the Department of Health and Social Care.

Keywords

GENERAL PRACTICE, Health policy, Information technology, PRIMARY CARE, Quality improvement

Creative Commons License

Creative Commons Attribution 4.0 International License
This work is licensed under a Creative Commons Attribution 4.0 International License.

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