ORCID

Abstract

Introduction: Intermediate care (IC) was redesigned to manage more complex, older patients in the community, avoid admissions and facilitate earlier hospital discharge. The service was ‘enhanced’ by employing GPs, pharmacists and the voluntary sector to be part of a daily interdisciplinary team meeting, working alongside social workers and community staff (the traditional model).Methods: A controlled before-and-after study, using mixed methods and a nested case study. Enhanced IC in one locality (Coastal) is compared with four other localities where IC was not enhanced until the following year (controls), using system-wide performance data (N = 4,048) together withad hocdata collected on referral-type, staff inputs and patient experience (N = 72).Results: Coastal showed statistically significant increase in EIC referrals to 11.6% (95%CI: 10.8%–12.4%), with a growing proportion from GPs (2.9%, 95%CI: 2.5%–3.3%); more people being cared for at home (10.5%, 95%CI: 9.8%–11.2%), shorter episode lengths (9.0 days, CI 95%: 7.6–10.4 days) and lower bed-day rates in ≥70 year-olds (0.17, 95%CI: 0.179–0.161). The nested case study showed medical, pharmacist and voluntary sector input into cases, a more holistic, coordinated service focused on patient priorities and reduced acute hospital admissions (5.5%).Discussion and conclusion: Enhancing IC through greater acute, primary care and voluntary sector integration can lead to more complex, older patients being managed in the community, with modest impacts on service efficiency, system activity, and notional costs off-set by perceived benefits.

Publication Date

2022-02-14

Publication Title

International Journal of Integrated Care

Volume

22

Issue

1

ISSN

1568-4156

Acceptance Date

2022-01-28

Deposit Date

2022-02-14

Embargo Period

2022-02-16

Funding

This work was funded by the Torbay Medical Research Fund (http://www.torbaymrf.info/) and supported by the National Institute for Health Research Applied Research Collaboration South West Peninsula (PenARC). The views expressed in this publication are those of the authors and not necessarily those of the PenARC or the Department of Health and Social Care. This evaluation was supported by Torbay Medical Research Fund (TMRF project number 120) and Torbay and South Devon NHS Foundation Trust (TSDFT).

Keywords

intermediate care, multi-disciplinary teams, person-centred care, voluntary sector, early supported discharge

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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