Key points

  • The NHS is developing new ways of delivering health care, yet local teams often lack access to the analytical skills they need to judge whether improvements are being made to the quality of the care received by patients. To help meet this need, the Health Foundation has partnered with NHS England to establish the Improvement Analytics Unit. The unit will feed back information on a regular basis to teams participating in transformation programmes in England.
  • This briefing represents the first output from the Improvement Analytics Unit. It concerns the impact of providing enhanced support for older people living in 22 care homes in Rushcliffe, and in one care home in a neighbouring area of Nottinghamshire. The enhanced support was developed by Principia, a local partnership of general practices, patients and community services. The package included aligning care homes with general practices, regular visits from a named GP, improved support from community nurses, independent advocacy and support from the third sector, and a programme of work to engage and support care home managers.
  • The Improvement Analytics Unit examined the impact of the enhanced support on hospital utilisation using newly developed linked care home and hospital data. Residents of Principia care homes were compared with a matched comparison group, consisting of similar individuals living in similar care homes in comparable areas of England.
  • Principia care home residents attended accident and emergency (A&E) departments 29% less often than the matched comparison group, and were admitted to hospital as an emergency 23% less frequently. There was no evidence of an impact on the number of nights a person spent in hospital, elective admissions or outpatient attendances. Residents in the Principia care homes were just as likely to die outside of hospital as matched comparison residents.
  • Assuming the two groups were comparable, the most likely explanation of the Improvement Analytics Unit's findings is that they reflect higher quality care for residents of the Principia care homes. The matched comparison group had similar age, gender, health conditions and prior hospital utilisation to the Principia residents, although they may have differed in unobserved ways.
  • Before the approaches used are replicated elsewhere, it is important to understand the causes of the lower observed use of emergency care. It is not possible to tell from this analysis what might have been the ‘active ingredient(s)’ leading to the lower rates. This could be related to the enhanced support, some other aspect of care delivery or local context. A process evaluation (looking at the context, implementation and how the package might have impact) would help to identify the active ingredients.
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