Hospital avoidance: an integrated community system to reduce acute hospital demand

McGeoch, Graham; Shand, Brett; Gullery, Carolyn; Hamilton, Greg; Reid, Matthew

doi:10.1017/s1463423619000756

Cited by 13 publications

(15 citation statements)

References 34 publications

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“…inadequate, or inaccessible IT communication resources) (Ivbijaro et al , 2015; McGonigle and McGeoch, 2017). Facilitators of communication meanwhile were shown to include conscious efforts to build strong and trusting relationships between stakeholders, the encouragement of service user involvement with regards to designing care models and self-care, greater staff involvement with service users' communities, and highly available and efficient IT resources dedicated to service user consultation, safe service user transfer and general care team activities (McGeoch et al , 2019; Nicholson et al , 2013; Røsstad et al , 2013; Timmons and Ham, 2013).…”

Section: Resultsmentioning

confidence: 99%

“…The whole-system approach emphasises not only what is “best for people”, but also what is “best for system”, and its success depends on how well professionals at all levels of care systems work together and take sufficient levels of responsibility and accountability. The whole-system approach was particularly well evidenced by studies documenting the “Canterbury Model” of IC (Gullery and Hamilton, 2015; McGeoch et al , 2019).…”

Section: Resultsmentioning

confidence: 99%

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What are the priorities for the future development of integrated care? A scoping review

Burke

Broughan

McCombe

et al. 2021

JICA

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Purpose“Integrated care” (IC) is an approach to health and social care delivery that aims to prevent problems arising from fragmented care systems. The collective content of the IC literature, whilst valuable, has become extensive and wide-ranging to such a degree that knowing what is most important in IC is a challenge. This study aims to address this issue.Design/methodology/approachA scoping review was conducted using Arksey and O'Malley's framework to determine IC priority areas.FindingsTwenty-one papers relevant to the research question were identified. These included studies from many geographical regions, encompassing several study designs and a range of populations and sample sizes. The findings identified four priority areas that should be considered when designing and implementing IC models: (1) communication, (2) coordination, collaboration and cooperation (CCC), (3) responsibility and accountability and (4) a population approach. Multiple elements were identified within these priorities, all of which are important to ensuring successful and sustained integration of care. These included education, efficiency, patient centredness, safety, trust and time.Originality/valueThe study's findings bring clarity and definition to what has become an increasingly extensive and wide-ranging body of work on the topic of IC. Future research should evaluate the implementation of these priorities in care settings.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

What are the priorities for the future development of integrated care? A scoping review

Burke

Broughan

McCombe

et al. 2021

JICA

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“…This finding supports previous results highlighting the need to design a specific pathway by which people in IHC can access routine services in order to avoid inappropriate ED visits. 24 In the last years, the Italian Government's focus, beyond strengthening IHCs and creating a structured network, has been on implementing telemedicine to enable physicians to provide remote monitoring, diagnosis, and consultations. 25 Coherently with previous studies, [26][27][28] respiratory disorders were the most frequent ED triage symptoms.…”

Section: Discussionmentioning

confidence: 99%

Emergency Department Visits Before, After and During Integrated Home Care: A Time Series Analyses in Italy

Campagna¹,

Conti²,

Dimonte³

et al. 2022

Int J Health Policy Manag

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Background: Integrated home care (IHC) is one strategy to provide care to people with multiple chronic conditions, and it contributes to the reduction of unnecessary emergency department (ED) use, but there are conflicting results on its effectiveness. In this study, we assessed the frequency and characteristics of ED visits occurring before, during, and after IHC in a large cohort of IHC patients enrolled over 6 years. Methods: The analysis included 39,822 IHC patients identified in Italian administrative databases. Patients were grouped in tertiles according to IHC duration (short, intermediate, and long) and the number of ED visits during IHC was compared to that the 12 months before IHC enrolment and in the 12 months after IHC discharge across IHC duration groups. Results: We observed a reduction in ED visits during IHC. IHC was significantly associated with a reduction in ED visits in the long and short IHC duration groups. A non-significant reduction in ED visits was observed in the intermediate IHC duration group. A 90% reduction in ED visits during IHC and a 45% reduction after IHC was observed in the short IHC duration group. Corresponding reductions were 17% and 64% during and after IHC, respectively, in the long IHC duration group. Conclusion: IHC was effective in reducing ED visits, but expansion of IHC to include additional necessary services could further reduce ED visits. Investment in the creation of a structured, effective network of engaged professionals (including community care services and hospitals) is crucial to achieving this.

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“…There is a range of hospital avoidance programmes reported in the literature and currently operating, and they vary in terms of target populations and when and where they are delivered 10 . Multiple studies have established the effectiveness of hospital avoidance programmes in terms of reducing length of stay and hospital readmissions, with no adverse effects on clinical outcomes and increased patient satisfaction 10–12 . It has also been suggested that hospital avoidance programmes may generate longer term benefits for certain clinical groups, such as patients with chronic conditions, allowing a greater focus on integration of care across primary care and hospital systems, with improved follow‐up and monitoring of conditions 13,14 …”

Section: Introductionmentioning

confidence: 99%

Economic evaluation of a medical ambulatory care service using a single group interrupted time‐series design

Pincombe

Schultz

Hofmann

et al. 2022

Evaluation Clinical Practice

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Rationale: Increasing demand for hospital services can lead to overcrowding and delays in treatment, poorer outcomes and a high cost-burden. The medical ambulatory care service (MACS) provides out of hospital patient care, including diagnostic and therapeutic interventions for patients that require urgent attention, but which can be safely administered in the ambulatory environment. The programme is yet to be rigorously evaluated.Aims/Objectives: The aim of this study is to evaluate the impact of the MACS programme on emergency department (ED) presentations, hospital admissions, length-of-stay and health service costs from a health system perspective. Method:We used a single group interrupted time series methodology with a multiple baseline approach to analyse the impact of the MACS clinic on ED presentations, hospital admissions, length-of-stay and cost outcomes for general practitioners (GP)-referred, ED-referred and ward-referred patients under two counterfactual scenarios: an increasing trend in health utilization based on preperiod predictions or a stabilization of utilization rates. Results:The time trend of hospital utilization differed after attending MACS for all three referral groups. The time trend for the GP-referred group declined significantly by 0.36 ED presentations per 100 patients per 30 days [95% confidence interval (CI): −0.52 to −0.2], while inpatient length of stay declined significantly by 1.56 and 3.70 days, respectively, per 100 ED-referred and ward-referred patients per 30 days (95% CI: −2.51 to −0.57 and −5.71 to −1.69, respectively). Under two different counterfactual scenarios, the predicted net savings for MACS across three patient

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Hospital avoidance: an integrated community system to reduce acute hospital demand

Cited by 13 publications

References 34 publications

What are the priorities for the future development of integrated care? A scoping review

What are the priorities for the future development of integrated care? A scoping review

Emergency Department Visits Before, After and During Integrated Home Care: A Time Series Analyses in Italy

Economic evaluation of a medical ambulatory care service using a single group interrupted time‐series design

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