Implications and priorities for future work

 

Since a single evaluation can only provide so much information, the findings need to be seen within the broader literature. Unfortunately, there are not many other studies to draw on. In 2014, a systematic review was published that summarised the evidence on approaches to reduce acute hospital admissions from care homes. It found only 11 studies. Several of these examined geriatric specialist services, often using comprehensive geriatric assessment., Others examined ways to structure and standardise clinical practice, for example by eliciting and recording preferences for future treatment,,, identifying residents whose goals and preferences are consistent with hospice care, improving the detection and management of pneumonia,, and improving the management of chronic obstructive pulmonary disease. While some of the individual studies found reductions in acute admissions, the systematic review concluded that the evidence was of low or very low quality.

Some insights are available from a previous Health Foundation-funded initiative. In the Safer Clinical Systems programme, a team used techniques adapted from high-risk industries to try to reduce readmission rates from care homes. There was little discernible reduction in hospital activity as a result of the programme, but valuable insights are nevertheless available from a process evaluation of it. The crux of the story is that, in that instance, the interventions were developed largely by a team based in the local hospital, without much involvement from the surrounding care homes, where there was a different understanding of the causes of readmission. The interventions therefore aimed to deal with the problems perceived by the hospital team (such as poor communication, and low levels of capacity within care homes), but missed some other problems, meaning that uptake and impact were poor. In contrast, Principia has had a programme of work to build relationships across organisational boundaries, engaging care home teams. It is possible that this has led to greater common understanding of the nature of the problems that need to be addressed and, therefore, more effective interventions. Coproduction is also one of the elements of the framework for enhanced health in care homes that emerged from the New Care Models programme.

Overall, it seems that the evidence regarding use of hospital care is much more sparse for care home residents than for adults living outside these settings in the community. However, future improvement efforts might benefit from the data linkage methods presented in this briefing. Indeed, one of the problems in this area is that very little is known about admissions from care homes, and therefore baseline rates have been difficult to establish. One of the few previous studies was published as part of QualityWatch and examined hospital admissions data for post code areas containing care homes. The Improvement Analytics Unit has built on that previous study by linking data more precisely, using the full address, while still protecting the identity of the individuals concerned. The approach might serve as a model for the future.

A recurrent message from the Health Foundation’s improvement work is that, to improve the quality of care, repeated measurement is necessary to allow timely modification of initiatives, and inform their more effective evolution. Over the coming years, the Improvement Analytics Unit will analyse more local initiatives, feeding back analysis quickly to inform ongoing decision making and practice. To find out more, visit www.health.org.uk/IAU


††† QualityWatch is a joint research programme from the Health Foundation and the Nuffield Trust. For more details, see: www.qualitywatch.org.uk

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