Case management for at-risk elderly patients in the English integrated care pilots: observational study of staff and patient experience and secondary care utilisation
<strong>Introduction:</strong><span style="text-decoration: underline;"> </span>In 2009, the English Department of Health appointed 16 integrated care pilots which aimed to provide better integrated care. We report the quantitative results from a multi-method evalua...
| Main Authors: | , , , , , , , , , , , |
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| Format: | Article |
| Language: | English |
| Published: |
Ubiquity Press
2012-07-01
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| Series: | International Journal of Integrated Care |
| Subjects: | |
| Online Access: | http://www.ijic.org/articles/850 |
| _version_ | 1819231106160918528 |
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| author | Martin Roland Richard Lewis Adam Steventon Gary Abel John Adams Martin Bardsley Laura Brereton Xavier Chitnis Annalijn Conklin Laura Staetsky Sarah Tunkel Tom Ling |
| author_facet | Martin Roland Richard Lewis Adam Steventon Gary Abel John Adams Martin Bardsley Laura Brereton Xavier Chitnis Annalijn Conklin Laura Staetsky Sarah Tunkel Tom Ling |
| author_sort | Martin Roland |
| collection | DOAJ |
| description | <strong>Introduction:</strong><span style="text-decoration: underline;"> </span>In 2009, the English Department of Health appointed 16 integrated care pilots which aimed to provide better integrated care. We report the quantitative results from a multi-method evaluation of six of the demonstration projects which used risk profiling tools to identify older people at risk of emergency hospital admission, combined with intensive case management for people identified as at risk. The interventions focused mainly on delivery system redesign and improved clinical information systems, two key elements of Wagner's Chronic Care Model. <strong>Methods:</strong><span style="text-decoration: underline;"> </span>Questionnaires to staff and patients. Difference-in-differences analysis of secondary care utilisation using data on 3,646 patients and 17,311 matched controls, and changes in overall secondary care utilisation. <strong>Results:</strong><span style="text-decoration: underline;"> </span>Most staff thought that care for their patients had improved. More patients reported having a care plan but they found it significantly harder to see a doctor or nurse of their choice and felt less involved in decisions about their care. Case management interventions were associated with a 9% increase in emergency admissions. We found some evidence of imbalance between cases and controls which could have biased this estimate, but simulations of the possible effect of unobserved confounders showed that it was very unlikely that the sites achieved their goal of reducing emergency admissions. However, we found significant reductions of 21% and 22% in elective admissions and outpatient attendance in the six months following an intervention, and overall inpatient and outpatient costs were significantly reduced by 9% during this period. Area level analyses of whole practice populations suggested that overall outpatient attendances were significantly reduced by 5% two years after the start of the case management schemes. <strong>Conclusion:</strong> Case management may result in improvements in some aspects of care and has the potential to reduce secondary care costs. However, to improve patient experience, case management approaches need to be introduced in a way which respects patients' wishes, for example the ability to see a familiar doctor or nurse. |
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| format | Article |
| id | doaj.art-e6f94eeecd0246768e2a4fbf871b7359 |
| institution | Directory Open Access Journal |
| issn | 1568-4156 |
| language | English |
| last_indexed | 2024-12-23T11:39:41Z |
| publishDate | 2012-07-01 |
| publisher | Ubiquity Press |
| record_format | Article |
| series | International Journal of Integrated Care |
| spelling | doaj.art-e6f94eeecd0246768e2a4fbf871b73592022-12-21T17:48:32ZengUbiquity PressInternational Journal of Integrated Care1568-41562012-07-0112510.5334/ijic.850874Case management for at-risk elderly patients in the English integrated care pilots: observational study of staff and patient experience and secondary care utilisationMartin Roland0Richard Lewis1Adam Steventon2Gary Abel3John Adams4Martin Bardsley5Laura Brereton6Xavier Chitnis7Annalijn Conklin8Laura Staetsky9Sarah Tunkel10Tom Ling11University of CambridgeErnst and Young LLPNuffield TrustUniversity of CambridgeRAND CorporationNuffield TrustRAND EuropeNuffield TrustRAND EuropeRAND EuropeErnst and Young LLPRAND Europe<strong>Introduction:</strong><span style="text-decoration: underline;"> </span>In 2009, the English Department of Health appointed 16 integrated care pilots which aimed to provide better integrated care. We report the quantitative results from a multi-method evaluation of six of the demonstration projects which used risk profiling tools to identify older people at risk of emergency hospital admission, combined with intensive case management for people identified as at risk. The interventions focused mainly on delivery system redesign and improved clinical information systems, two key elements of Wagner's Chronic Care Model. <strong>Methods:</strong><span style="text-decoration: underline;"> </span>Questionnaires to staff and patients. Difference-in-differences analysis of secondary care utilisation using data on 3,646 patients and 17,311 matched controls, and changes in overall secondary care utilisation. <strong>Results:</strong><span style="text-decoration: underline;"> </span>Most staff thought that care for their patients had improved. More patients reported having a care plan but they found it significantly harder to see a doctor or nurse of their choice and felt less involved in decisions about their care. Case management interventions were associated with a 9% increase in emergency admissions. We found some evidence of imbalance between cases and controls which could have biased this estimate, but simulations of the possible effect of unobserved confounders showed that it was very unlikely that the sites achieved their goal of reducing emergency admissions. However, we found significant reductions of 21% and 22% in elective admissions and outpatient attendance in the six months following an intervention, and overall inpatient and outpatient costs were significantly reduced by 9% during this period. Area level analyses of whole practice populations suggested that overall outpatient attendances were significantly reduced by 5% two years after the start of the case management schemes. <strong>Conclusion:</strong> Case management may result in improvements in some aspects of care and has the potential to reduce secondary care costs. However, to improve patient experience, case management approaches need to be introduced in a way which respects patients' wishes, for example the ability to see a familiar doctor or nurse.http://www.ijic.org/articles/850integrated careolder peoplecase managementpatient experiencestaff experiencehospital utilisationrisk stratificationEngland |
| spellingShingle | Martin Roland Richard Lewis Adam Steventon Gary Abel John Adams Martin Bardsley Laura Brereton Xavier Chitnis Annalijn Conklin Laura Staetsky Sarah Tunkel Tom Ling Case management for at-risk elderly patients in the English integrated care pilots: observational study of staff and patient experience and secondary care utilisation International Journal of Integrated Care integrated care older people case management patient experience staff experience hospital utilisation risk stratification England |
| title | Case management for at-risk elderly patients in the English integrated care pilots: observational study of staff and patient experience and secondary care utilisation |
| title_full | Case management for at-risk elderly patients in the English integrated care pilots: observational study of staff and patient experience and secondary care utilisation |
| title_fullStr | Case management for at-risk elderly patients in the English integrated care pilots: observational study of staff and patient experience and secondary care utilisation |
| title_full_unstemmed | Case management for at-risk elderly patients in the English integrated care pilots: observational study of staff and patient experience and secondary care utilisation |
| title_short | Case management for at-risk elderly patients in the English integrated care pilots: observational study of staff and patient experience and secondary care utilisation |
| title_sort | case management for at risk elderly patients in the english integrated care pilots observational study of staff and patient experience and secondary care utilisation |
| topic | integrated care older people case management patient experience staff experience hospital utilisation risk stratification England |
| url | http://www.ijic.org/articles/850 |
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