Care closer to home for children and young people who are ill: developing and testing a model of service delivery and organization

Abstract

Care closer to home services are an established part of care for children and young people who are ill. They deal with complex and technical care and can prevent or reduce the length of acute hospital admission. Lack of readily available information about caseloads, case mix and costs may hamper their further development.

Paediatric ‘care closer to home’: Stake-holder views and barriers to implementation

“…This lack of clarity regarding the purpose of CCTH contributed to difficulties in making judgements about a suitable model for communitybased outpatient care. This finding, which is echoed by Parker et al (2011b), suggests that clearer objectives may facilitate CCTH policy implementation by providing a set of desired outcomes from which models can be developed, implemented and evaluated. This should include a number of factors, such as the mix of patients, professional skills, equipment and training required for each service and each population, as well as ensuring that the physical environments of service delivery are sufficient, appropriate and child-friendly (DoH, 2003).…”

“…We are currently carrying out work to explore the views, experiences and behaviours of parents, children and young people regarding community-based paediatric outpatient clinics. This is important as families' views are underrepresented in existing evidence (Parker et al, 2011b); despite policy dictating that 'closer to home' services will deliver patient-centred care.…”

“…Many of the Care Closer to Home (CCTH) evaluations carried out to date have focused on adult outpatient services (Bowling et al 1997;Bond et al, 2000;Bowling and Bond, 2001;Sibbald et al, 2007Sibbald et al, , 2008, or on preventing inpatient admission and reducing length of stay (Parker et al, 2011a(Parker et al, , 2011b. Thus despite a policy drive for paediatric CCTH, there remain gaps in existing evidence about the appropriateness of this model for specialist paediatric outpatient services, namely the acceptability of the model by parents, patients and healthcare professionals, and the extent to which any of the proposed benefits have been achieved (McLellan, 1995).…”

Introducing consultant outpatient clinics to community settings to improve access to paediatrics: an observational impact study

“…In 2006, the Department of Health in England announced a major policy to move some care from hospital settings ‘closer to home’ in community locations 2. The limited available evidence suggests that patient access may be improved, but that the impact on system efficiency is unclear 5 6…”

“…In 2006, the BCH decided to pilot the provision of outpatient appointments in community settings, here designated ‘satellite’ clinics, in addition to those at the city centre hospital. The impetus for this quality improvement initiative was derived from the national ‘closer to home’ policy5 and had two locally determined objectives: first, to reduce non-attendance at appointments by providing care in more accessible locations; second, to create new physical capacity for holding outpatient clinics as the hospital outpatient department had a full schedule of clinic sessions and so was unable to allocate additional clinic sessions to general paediatrics. In addition to the quality improvement benefits associated with enhanced convenience and experience for patients and parents, the initiative had potential benefits for patient health outcomes if greater attendance could be achieved.…”