Alternatives to Hospital: Models of Integrated Care

Transcription

1 Alternatives to Hospital: Models of Integrated Care Tom Bowen The Balance of Care Group IMA Health 2007, London, UK 2 April 2007

2 Projects taking whole systems approach Sheffield Designed community services for proactive care of chronic diseases and frailty Management Management of of Long-Term Long-Term Conditions Conditions Specialist Specialist Nursing Nursing Wexham Park Hospital Redesigned discharge planning process Rehabilitation Services Better Use Of Beds Discharge Planning Oxfordshire Design of Community Hospital and Community Staffing requirements Focus Focus on on Prevention Prevention Service Service Reconfiguration Reconfiguration North Hampshire Reduction in number of beds by 60 through identification of nursing and therapy staffing needs 2

3 Rich Picture of Process Flow Stage Pre Pre admission admission Admission Diagnosis Treatment Discharge Data Collected Identification of vulnerable people Social factors (housing, informal care) Risk factors (drugs, comorbidity, dementia, etc) Source of referral Time of admission Route Referral Source Reason for admission Admission diagnosis Inpatient diagnosis Delays in diagnosis Chronic disease Delays in therapy Delays in planning Delays in discharge Opportunities Preventive care Chronic disease management Alternatives to admission to acute setting Alternative sites for diagnosis Diagnostics Required Alternative settings for therapy (especially rehab) Alternative sites for discharge 3

4 Point Prevalence Surveys All inpatients in selected specialties on a single day Acute and elderly medicine, & orthopaedics Data collected from casenotes by clinical staff Use Appropriateness Evaluation Protocol (AEP) to identify possibly non-acute patients Also survey non-acute hospitals Follow up discharge outcomes to provide basis for demand analysis 4

5 On admission AEP Criteria Severity of illness eg unconscious, unable to move (fall), acute bleeding Intensity of service eg surgery + gen anaesthesia, regular monitoring, IV therapy On day of care Medical services Nursing services Patient condition eg acute confusion, other acute states, coma, fever 5

6 Results from Typical Acute Hospital 12% of all patients admitted outside AEP criteria 43% of all patients outside AEP criteria on day of survey Clinicians assess preferred alternative type and location of care Age of patients in acute hospital % % % % 6

7 AEP comparison for medical patients Outside AEP on admission Outside AEP on the day East Berkshire 15% 47% Cambridge 16% 47% Oxfordshire 20% 49% East Surrey 15% 50% NW Surrey 16% 57% 7

8 Other Other Acute Medicine - Alternatives for Patients admitted outside AEP Criteria (N = 146) 8 Home Home Home Home + social social care care Home Home + spec spec nurse nurse Home Home + therapy therapy OP/day OP/day hosp hosp Mental Mental health health care care Non Non acute acute bed bed Non Non acute acute bed bed + therapy therapy Home + general care Home + general care No of patients

9 Acute Medicine - Alternatives for Patients outside AEP on the Day (N = 364) Non-acute Acute 9 Home + social care Home + specialist nurse Home + therapy Mental health care Non acute bed Non acute bed + nursing Non acute bed + therapy Other Home + general care Home No of Patients

10 Acute Medicine - Alternatives for Patients not 'Discharged Quickly' (N = 229) Non-acute Acute 10 Home + social care Home + specialist nurse Home + therapy Mental health care Non acute bed Non acute bed + nursing Non acute bed + therapy Other Home + general care Home No of Patients

11 Potential Change in Service Usage Acute Medicine & Orthopaedics +143 Home based care packages +48 Acute beds +88 Care Home (short term beds) EMH +17 Care Home (long term beds) 11

12 Some implications Change to the clinical process is needed if service development to deliver benefits AEP values characterise the nature of the UK hospital service, and potential to develop can we model this? Is there an analogous approach that would allow us to model alternatives for long term conditions? 12