The assessment of patient need for intermediate care in Medway and Swale

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The assessment of patient need for intermediate
care in Medway and Swale

• Methodology, results and way forward

Jennifer Butt, Intermediate Care Project Manager,
Medway PCT Mavis Williams, Matrix Research
Consultancy 21 May 2004
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Three patients

• Emily, 88, lives independently, has hysterectomy.
  After 5 days in hospital no longer needs acute
  care.
• Peter has COPD. Contacted his GP because he was
  feeling unwell, needs medication advice oxygen
• Lily, 80, has carers (formal informal), home
  adaptations. Has fallen, lacks confidence. In
  acute hospital for two weeks (and counting)

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Session will cover

• Medway and Swale
• Definition of intermediate care
• Aims and objectives
• Principles
• Approach and process
• Results
• What happened next
• Lessons learnt

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Medway and Swale

• Medway PCT 275k population, Swale PCT 98k
• 1 acute trust (580 beds)
• 3 community hospitals (159 beds)
• IC services 200-250 patients at a time
• 50 IC beds

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What is intermediate care?

• Intermediate care is a range of needs-led,
  transitional and integrated services that are
  intended to maximise health gain and
• prevent unnecessary admission to an acute
  hospital
• bed
• support timely discharge
• reduce avoidable use of long-term care
• maximise independent living
• These services are delivered in partnership
  between primary and secondary health care, local
  government services (in particular social care)
  and the independent sector

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Aims

• To develop an intermediate care services
  strategy for Medway and Swale
• To focus on mapping the need for intermediate
  care in Medway and Swale

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Objectives

• To understand the need for intermediate care
  services by profiling expected levels of need for
  intermediate care in Medway and Swale
• To identify the numbers of people who need
  intermediate care by undertaking a survey in
  order to produce
• an estimate of the level of need
• the type and intensity of that need
• the ideal setting in which the identified care
  package should be provided

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Principles

• A guide to planning
• A snapshot of need
• Patient need, not service need
• Not constrained by current service levels/
  configuration
• Not a be all and end all, but valuable evidence
• Validation from and involvement of local
  stakeholders (tool, definitions and findings)

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Process

• Needs profile work
• Collecting national and local socio-economic and
  demographic data sources to produce a
  population-based picture of need for intermediate
  care services
• Intermediate care survey
• Undertaken in Medway Maritime hospital, community
  hospitals, day hospitals, the rapid response team
  and the community respiratory team
• Stakeholder questionnaire
• To determine unmet need of individuals not
  currently accessing the services

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Theoretical framework
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Issues

• Needs profile work
• Provided useful information but did not provide
  the kind of information required for planning
  purposes
• Stakeholder questionnaire
• Poor response
• Did not produce robust numbers of people in need
  of intermediate care as answers were of a
  qualitative nature
• However, questionnaires and discussions with
  practitioners indicated that there is a perceived
  high need for intermediate care within the
  community

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Needs assessment survey tool

• Principles
• Simple
• Quick to administer
• Reliable and robust
• Uses accessible data/sample
• Clearly defined to avoid misinterpretation
• Looks at the ideal situation not looking to
  alter individual care packages

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Development of the needs assessment survey

• Planning and research to develop tool and
  sampling
• Stakeholder involvement and ownership
• Practitioner workshops to validate and adapt tool
  and to agree definition of intermediate care
• Training and selection of census team
• Undertaking census
• Analysis of census
• Validation by stakeholders of findings
• Report

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Needs assessment survey

• Sample all patients in the identified locations,
  excluding maternity, paediatrics, AE, mental
  health
• By whom a team of practitioners representing a
  range of skills
• 2 nursing representatives
• 2 therapy representatives
• 1 social care representative

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Needs assessment tool

• Design
• Screening to identify those in need of IC
• Patient profile to identify profile of those in
  need of IC
• Care types nursing, medical care,
  rehabilitation/therapy, social/personal care
• Intensity measured in frequency of visits
• Ideal setting

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Survey results

• 871 individuals included in the survey
• 395 (45) of them required intermediate care

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Patient profile

• 2.8 women 1 man
• 3 BME
• Age

3
5
13
18
18-44
45-64
65-74
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75-84
85
Missing
44
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Intermediate care needs
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Ideal setting for care
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What happened next

• Patient practitioner survey
• Widespread circulation of census results
• Census validation
• Impact of IC on RH/NH admissions

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Patient practitioner consultation surveys

• 779 patients, carers public
• 93 value IC
• Top priority (74) Knowing what services are
  available
• 207 practitioners
• 92 value IC
• Top priority as providers (59) Sufficient
  resources
• Top priority as referrers (75) Sufficient
  resources

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Census validation, Feb 2004

• University of Greenwich
• 40 IC patients identified, 29 interviewed 7
  carers
• Patients needed therapy rather than medical /
  nursing care
• Some concern about confusion
• Patient carer views vs. MDT views

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Impact of IC on RH/NH admissions

• 47 patients
• Home gt acute hospital (gt community hospital) gt
  permanent care home
• 15 could have had IC
• 12 could have stayed home after IC (for min. one
  year?)
• 63 of admissions to nursing homes are from
  hospital

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Implications

• Community-based IC staffing, expertise,
  out-of-hours
• Speed up equipment, diagnostics
• Reconfigure beds
• Major changes time, money, culture

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Lessons learnt

• Needs assessment survey
• Dependency on census team
• RH/NH needs
• Diagnosis information
• Input from patients, carers, ward staff
• Definition of intermediate care
• Difficulty of separating need from supply
• Degree of culture change required

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Three patients

• Emily, 88, lives independently, has hysterectomy.
  After 5 days in hospital no longer needs acute
  care.
• Peter has COPD. Contacted his GP because he was
  feeling unwell, needs medication advice oxygen
• Lily, 80, has carers (formal informal), home
  adaptations. Has fallen, lacks confidence. In
  acute hospital for two weeks (and counting)

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The challenge

• Having worked out what people need (needs
  assessment)
• and what people want (consultation surveys)
• we need to ensure that they get it