Innovative management of complex, chronic disorders in older people

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Innovative management of complex, chronic
disorders in older people
Khim Horton Tom Daly Wendy Knibb Karen Bryan
HWRC, University of Surrey, UK
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Overview

• this project evaluated the pilot of an innovative
  method of managing the medical assessment and
  treatment for older people in a NHS Trust in
  England.

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The status quo

• older people access emergency care through
  self-referral, ambulance referral or GP referral
  to Accident and Emergency AE departments
  within NHS hospitals
• problems
• delays in assessment necessitating hospital stay
• delayed discharge back to the community

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Motivation for change UK Policy

• NHS Plan (2000) - performance indicators eg
• reduction of waiting times in A E hospital
  departments
• reduction of average length of stay in hospital
  settings
• Community Care (delayed discharges) Act (2003)
• Local Authorities to be fined for unnecessary bed
  occupancy in hospitals
• the above is set against a background of a
  shift away from
• secondary care towards care in the
  community

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Older people

• occupy c.70 of hospital beds
• (National Beds Inquiry 2000)
• are relatively heavy users of health care
  (Wanless 2002)
• have c.40-45 of NHS expenditure on health and
  social care spent on them
• (Select Committee on Public Accounts 29th
  Report July 2004)

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Purpose of the new ATC

• to provide fast-track, single assessment and in
  the main, same day treatment for older people who
  presented with particular chronic health problems
• also to reduce waiting times improve quality of
  service and improve working lives of members of
  the workforce

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Purpose of the project

• to evaluate the role of the Assessment and
  Treatment Centre ATC in terms of clinical
  outcomes, user satisfaction and economic
  considerations.
• also how the service linked with others within
  the area.

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ATC evaluation

• raw data collection of eg duration of stay
  service user destinations treatment skill-mix
• semi-structured interviews with 40 service users
• semi-structured interviews with 15 GPs
• comparison of findings with data using the status
  quo arrangements

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Duration of stay
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ATC service user destinations
Compare AE 2004 over 70 admissions
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Treatment costs n50
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Labour costs

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Satisfaction with the new service

• Service users out of a maximum positive score of
  55 the mean was above 43
• GPs the structure was appealing particularly the
  fast-track assessment element. Most would refer
  and hence potential demand could be high.

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So.

• the scheme was popular
• treatment costs were higher
• labour costs were marginally higher
• BUT these increased costs were outweighed
• by the large reduction in admissions
• 70 same day discharge to the community

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Other new service provision

• nurse-led clinics eg cancer follow-up
• specialist intermediate care teams for
• eg stroke victims
• rehabilitation teams that include specialist
• rehabilitation assistants eg Parkinsons
  Disease

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Further research

• effect of innovative service provision on choice
  and competition and hence efficiency
• effects over time
• generalisability of local innovative service
  provision