Effects of locality based community hospital care on independence in older people needing rehabilitation: randomised controlled trial

Green, John; Young, John; Forster, Anne; Mallinder, Karen; Bogle, Sue; Lowson, Karin; Small, Neil

doi:10.1136/bmj.38498.387569.8f

Cited by 58 publications

(79 citation statements)

References 20 publications

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“…There were seven papers reporting on four RCTs, 7,9,10,62,66,98,100 and two papers reporting on qualitative research embedded in two of the RCTs. 8,55 There were a further four papers reporting on three qualitative studies, and one paper on an observational cohort study.…”

Section: Resultsmentioning

confidence: 99%

“…53 Studies of community hospitals in England and Scotland typically reported on the provision of non-acute inpatient services, particularly post-acute geriatric care, rehabilitation services and palliative care. 7,[54][55][56][57][58] Indeed, several UK community hospitals provide exclusively, or largely, non-acute inpatient care to chronically ill or older populations. 7,38,56 Similarly, community hospitals in Ireland tend to focus on services for older people such as respite care, rehabilitation, palliative care long-stay facilities and community-based assessment.…”

Section: Range Of Services Provided By Community Hospitalsmentioning

confidence: 99%

“…7,[54][55][56][57][58] Indeed, several UK community hospitals provide exclusively, or largely, non-acute inpatient care to chronically ill or older populations. 7,38,56 Similarly, community hospitals in Ireland tend to focus on services for older people such as respite care, rehabilitation, palliative care long-stay facilities and community-based assessment. 59,60 Studies of community hospitals in Norway also described a focus on intermediate care, targeted at people who would otherwise face unnecessarily prolonged hospital stays or inappropriate admission to acute inpatient care, including chronically ill and older patients.…”

Section: Range Of Services Provided By Community Hospitalsmentioning

confidence: 99%

“…For example, studies examining the impact of rehabilitation care for older people found that the community hospital setting was associated with greater independence at 6 months than the district general hospital setting. [7][8][9][10][11] Other work has pointed to the potential role of community hospitals in providing palliative care. 12 It is reported that community hospitals are perceived as friendly and service-user centred; for example, evidence from the 2011 Scottish Inpatient Patient Experience Survey found that community hospitals scored above the national average on many questions concerning patient experience, 13 and it has been suggested that community hospitals offer a better experience of care than acute hospitals by allowing more integration with patients' families and home life.…”

Section: Introductionmentioning

confidence: 99%

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Community hospitals and their services in the NHS: identifying transferable learning from international developments – scoping review, systematic review, country reports and case studies

Pitchforth

Nolte

Corbett

et al. 2017

Health Serv Deliv Res

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BackgroundThe notion of a community hospital in England is evolving from the traditional model of a local hospital staffed by general practitioners and nurses and serving mainly rural populations. Along with the diversification of models, there is a renewed policy interest in community hospitals and their potential to deliver integrated care. However, there is a need to better understand the role of different models of community hospitals within the wider health economy and an opportunity to learn from experiences of other countries to inform this potential.ObjectivesThis study sought to (1) define the nature and scope of service provision models that fit under the umbrella term ‘community hospital’ in the UK and other high-income countries, (2) analyse evidence of their effectiveness and efficiency, (3) explore the wider role and impact of community engagement in community hospitals, (4) understand how models in other countries operate and asses their role within the wider health-care system, and (5) identify the potential for community hospitals to perform an integrative role in the delivery of health and social care.MethodsA multimethod study including a scoping review of community hospital models, a linked systematic review of their effectiveness and efficiency, an analysis of experiences in Australia, Finland, Italy, Norway and Scotland, and case studies of four community hospitals in Finland, Italy and Scotland.ResultsThe evidence reviews found that community hospitals provide a diverse range of services, spanning primary, secondary and long-term care in geographical and health system contexts. They can offer an effective and efficient alternative to acute hospitals. Patient experience was frequently reported to be better at community hospitals, and the cost-effectiveness of some models was found to be similar to that of general hospitals, although evidence was limited. Evidence from other countries showed that community hospitals provide a wide spectrum of health services that lie on a continuum between serving a ‘geographic purpose’ and having a specific population focus, mainly older people. Structures continue to evolve as countries embark on major reforms to integrate health and social care. Case studies highlighted that it is important to consider local and national contexts when looking at how to transfer models across settings, how to overcome barriers to integration beyond location and how the community should be best represented.LimitationsThe use of a restricted definition may have excluded some relevant community hospital models, and the small number of countries and case studies included for comparison may limit the transferability of findings for England. Although this research provides detailed insights into community hospitals in five countries, it was not in its scope to include the perspective of patients in any depth.ConclusionsAt a time when emphasis is being placed on integrated and community-based care, community hospitals have the potential to assume a more strategic role in health-care delivery locally, providing care closer to people’s homes. There is a need for more research into the effectiveness and cost-effectiveness of community hospitals, the role of the community and optimal staff profile(s).FundingThe National Institute for Health Research Health Services and Delivery Research programme.

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Section: Resultsmentioning

confidence: 99%

Section: Range Of Services Provided By Community Hospitalsmentioning

confidence: 99%

Section: Range Of Services Provided By Community Hospitalsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Community hospitals and their services in the NHS: identifying transferable learning from international developments – scoping review, systematic review, country reports and case studies

Pitchforth

Nolte

Corbett

et al. 2017

Health Serv Deliv Res

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“…However, the results are contradictory when comparisons are made to determine the effects on independence in older people needing rehabilitation. A study by Ro and Kim (1995) showed that non-institutionalised elderly had higher scores in Self Efficacy, Instrumental Activities of Daily Living and Quality of Life as compared to the institutionalised population; while Green et al (2005) reported that care in a locally-based community hospital is associated with greater independence for older people, than care in wards in a district general hospital.…”

Section: Introductionmentioning

confidence: 99%

Functional Independence and Quality of Life for Persons with Locomotor Disabilities in Institutional Based Rehabilitation and Community Based Rehabilitation - A Comparative Study

Balasubramanian¹,

Dhanesh²,

Amarnath³

2012

DCID

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Comprehensive geriatric assessment for older adults admitted to hospital

Ellis

Gardner

Tsiachristas

et al. 2011

Cochrane Database of Systematic Reviews

561

174

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Background Comprehensive geriatric assessment (CGA) is a multidimensional, interdisciplinary diagnostic process to determine the medical, psychological and functional capabilities of a frail elderly person in order to develop a co-ordinated and integrated plan for treatment and long-term follow up. Objectives We sought to evaluate the effectiveness of CGA in hospital for older adults admitted as an emergency. Search methods We searched the Cochrane Effective Practice and Organisation of Care (EPOC) Group Register, the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library), the Database of Abstracts of Reviews of Effects (DARE), MEDLINE, EMBASE, CINAHL and AARP Ageline, and handsearched high-yield journals. Selection criteria We searched for randomised controlled trials comparing CGA (whether by mobile teams or in designated wards) to usual care. Data collection and analysis Two review authors initially assessed eligibility and trial quality and extracted published data. Main results Twenty-two trials evaluating 10,315 participants in six countries were identified. Patients in receipt of CGA were more likely to be alive and in their own homes at up to six months (OR 1.25, 95% CI 1.11 to 1.42, P = 0.0002) and at the end of scheduled follow up (median 12 months) (OR 1.16, 95% CI 1.05 to 1.28, P = 0.003) when compared to general medical care. In addition, patients were less likely to be institutionalised (OR 0.79, 95% CI 0.69 to 0.88, P < 0.0001). They were less likely to suffer death or deterioration (OR 0.76, 95% CI 0.64 to 0.90, P = 0.001), and were more likely to experience improved cognition in the CGA group (OR 1.11, 95% CI 0.20 to 2.01, P = 0.02). Subgroup interaction in the primary outcomes suggests that the effects of CGA are primarily the result of CGA wards. Authors’ conclusions Comprehensive geriatric assessment increases a patient’s likelihood of being alive and in their own home at up to 12 months.

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Effects of locality based community hospital care on independence in older people needing rehabilitation: randomised controlled trial

Cited by 58 publications

References 20 publications

Community hospitals and their services in the NHS: identifying transferable learning from international developments – scoping review, systematic review, country reports and case studies

Community hospitals and their services in the NHS: identifying transferable learning from international developments – scoping review, systematic review, country reports and case studies

Functional Independence and Quality of Life for Persons with Locomotor Disabilities in Institutional Based Rehabilitation and Community Based Rehabilitation - A Comparative Study

Comprehensive geriatric assessment for older adults admitted to hospital

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