Implications and priorities for future work

These analyses reflect implementation part-way through the delivery of the enhanced support introduced in 15 care homes in Wakefield. In April 2017, after the period of this evaluation, an additional 12 care homes joined the vanguard and some new initiatives were introduced in the original 15 care homes. This evaluation supplements existing evidence derived by alternative methods delivered by the vanguard, and provides a different approach to evaluating the impact of the vanguard’s enhanced support.

The evaluation provides some useful insights on progress at this early stage. We found that there was promising evidence of an effect on potentially avoidable admissions, especially in the subgroup of residents who were in the study for at least three months, indicating that it may take some time before an intervention can affect a person’s outcomes. Extending the evaluation period to beyond March 2017, and potentially including the 12 care homes that received enhanced support from April 2017, would improve understanding of whether a longer follow-up period for residents is needed for there to be an effect.

Further quantitative analyses would be enhanced with targeted qualitative research to understand how the different initiatives are being implemented and the mechanisms through which the enhanced support interacts with contextual factors to affect emergency care use. One area of interest could be to look at the parts of the enhanced support that are likely to affect potentially avoidable emergency admissions, an area where we are seeing positive signs. This could also provide evidence that would inform whether certain elements of the enhanced support package may be more significant determinants of emergency care use than others.

With the data we had access to we could not observe how the different components of the enhanced support operated in practice or examine how the enhanced support interacted with contextual factors, but additional analyses could develop understanding further and provide more robust information to inform local implementation. For example, if data on MDT referrals were made available, the effect of MDTs could be isolated from other parts of the intervention thereby allowing for stronger conclusions to be drawn.

A recurrent message from the Health Foundation’s improvement work is that to improve the quality of care, repeated measurement and data linkage to get a fuller picture are 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.

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