Community Hospitals

A Study to Understand and Optimise Community Hospital Ward Care in the NHS

Background

Community Hospitals are a long established health care facility in the UK, and internationally. They can be loosely defined as small hospitals that provide a wide range of locality-based outpatient and inpatient services. There is high quality evidence that supports the community hospital as an effective bed-based rehabilitation service for older people. A multicentre study in England randomised patients (n=490) either to remain in a general hospital ward or to transfer to one of seven community hospitals. The main finding was significant greater functional independence and cost-effectiveness at six months for the patients allocated to the community hospital group. A similar single centre RCT in Norway (n=142) reported lower mortality and indirect evidence for increased independence for the community hospital group compared to the group receiving continued care in a general hospital.

Considerable additional information describing the contemporary community hospital is available from two other national surveys from NHS Benchmarking Network: the NHSBN Community Hospitals Project; and the National Audit of Intermediate Care (2012). These complementary surveys provide information on 180 community hospitals (or approximately two-thirds of the UK community hospitals). Two findings are prominent. Firstly, it is clear that a core function of the contemporary community hospital is rehabilitation for older people (rehabilitation provided in 97% of community hospitals). Secondly, the contemporary community hospital ward is characterised by extreme variability. The reasons behind these variations, and therefore their remedy,
are speculative as no detailed study has been designed and conducted to systematically investigate
the issue.

Aims & Objectives

We aim to use two existing data sets (the NHS Benchmarking Community Hospital Project and the National Audit of Intermediate Care) to describe in detail the current and potential performance of community hospital in-patient care for older people. Objectives of the study:

1. To measure the current relative performance of community hospital in-patient care for older people (what does current community hospital practice look like? – Study 1).
2. To identify the characteristics of community hospital in-patient care for older people that optimises performance (what does ‘best’ look like? – Study 1 and Study 2).
3. To investigate the current impact of community hospital in-patient care for older people on secondary care and the potential impact if the community hospital care was optimised to best practice nationally (What might the effects of “best” look like? Study 1).
4. To determine if there is an association between the configuration (capacity and proportions) of short-term, community-based services (i.e. community hospital wards, home-based rehabilitation, care home rehabilitation and enabling services) and reduction in secondary care bed utilisation by older people. (Is there an optimum whole system configuration, and what are the tolerances? Study 1).
5. To develop web-based interactive toolkits for use by local commissioners and community hospital teams that support operational changes to optimise performance (Study 4).

Methods (health economics)

Performance will be quantified by modelling cost efficiency. The model functions of interest include provider and ward organisation features; clinical and service level outcomes; patient experience; types of patient care; and costs. Our focus will be on analysing and describing community hospital ward care as applied to older people, that is, slow, medium and high intensity rehabilitation, and end of life care. The National Audit of Intermediate Care Round 2 (collected May 2013) also includes data sets on alternatives to community hospital ward care, namely: care home-based rehabilitation; home-based rehabilitation; and social service enablement services. We therefore have the opportunity to conduct large scale between-service comparisons and to assess the whole system impact of community based rehabilitation services for older people on secondary care provision. To ensure valid between-service comparisons, we will here restrict our focus to that of slow and medium term rehabilitation, and end of life care (high intensity rehabilitation is not a feature of care home-based  rehabilitation; home-based rehabilitation; and social service enablement). We are also working in partnership with the Community Hospitals Association to maximise the response rate to the upcoming round of the NHS Benchmarking Community Hospital Project to achieve a new comprehensive national survey of community hospitals.

Partners & Collaborators

John Young, Academic Unit of Elderly Care and Rehabilitation, University of Leeds

Mary Godfrey, Academic Unit of Elderly Care and Rehabilitation, University of Leeds

Andrew Smith, Institute for Transport Studies, University of Leeds

Pamela Enderby, Rehabilitation and Assistive Technology Research, University of Sheffield

Heather Eardley, The Patients Association

Claire Hulme, Academic Unit of Health Economics, University of Leeds

Roberta Longo, Academic Unit Of Health Economics, University of Leeds

Helen Tucker, Community Hospitals Association

John Gladman, School of Medicine, University of Nottingham

Funding

Funding Agency: NIHR Health Services & Delivery Research Programme

Grant Value: £520,000

Project Period: 2014-2017

NIHR Web Page: http://www.nets.nihr.ac.uk/projects/hsdr/1217704

Further Information

For further information contact Claire Hulme


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