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Effect on secondary care of providing enhanced support to residential and nursing home residents: a subgroup analysis of a retrospective matched cohort study
  1. Therese Lloyd1,
  2. Stefano Conti2,
  3. Filipe Santos2,
  4. Adam Steventon3
  1. 1 Improvement Analytics Unit, The Health Foundation, London, UK
  2. 2 Improvement Analytics Unit and Data, Analysis and Intelligence Services, NHS England, London, UK
  3. 3 Data Analytics, The Health Foundation, London, UK
  1. Correspondence to Therese Lloyd, Improvement Analytics Unit, The Health Foundation, London WC2E 9RA, UK; therese.lloyd{at}health.org.uk

Abstract

Background Thirteen residential care homes and 10 nursing homes specialising in older people in Rushcliffe, England, participated in an improvement programme. The enhanced support provided included regular visits from named general practitioners and additional training for care home staff. We assessed and compared the effect on hospital use for residents in residential and nursing homes, respectively.

Methods Using linked care home and administrative hospital data, we examined people aged 65 years or over who moved to a participating care home between 2014 and 2016 (n=568). We selected matched control residents who had similar characteristics to the residents receiving enhanced support and moved to similar care homes not participating in the enhanced support (n=568). Differences in hospital use were assessed for residents of each type of care home using multivariable regression.

Results Residents of participating residential care homes showed lower rates of potentially avoidable emergency admissions (rate ratio 0.50, 95% CI 0.30 to 0.82), emergency admissions (rate ratio 0.60, 95% CI 0.42 to 0.86) and Accident & Emergency attendances (0.57, 95% CI 0.40 to 0.81) than matched controls. Hospital bed days, outpatient attendances and the proportion of deaths that occurred out of hospital were not statistically different. For nursing home residents, there were no significant differences for any outcome.

Conclusions The enhanced support was associated with lower emergency hospital use for older people living in residential care homes but not for people living in nursing homes. This might be because there was more potential to reduce emergency care for people in residential care homes. In nursing homes, improvement programmes may need to be more tailored to residents’ needs or the context of providing care in that setting.

  • healthcare quality improvement
  • health services research
  • nursing homes
  • quality improvement

This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/.

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Footnotes

  • Contributors AS and TL designed the study. FS did the data management and national analysis. SC and TL performed the subgroup analysis. TL drafted the first version of the paper. All authors revised and contributed to the paper, and read and approved the final manuscript.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests SC and FS are under full employment of NHS England.

  • Patient consent for publication Not required

  • Provenance and peer review Not commissioned; externally peer reviewed.

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