Long-term care provision, hospital bed blocking, and discharge destination for hip fracture and stroke patients

Gaughan, James; Gravelle, Hugh; Santos, Rita; Siciliani, Luigi

doi:10.1007/s10754-017-9214-z

Cited by 31 publications

(65 citation statements)

References 33 publications

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“…This expands on previous work that has examined the impact of social care provision on delayed exits from hospitals (Fernandez and Forder, 2008;Gaughan et al, 2015;Gaughan et al, 2017), and develops further evidence on the interdependence of hospital and social care services.…”

Section: Introductionsupporting

confidence: 52%

“…They also find significant spillovers between local authorities, with lower availability of beds in neighbouring local authorities associated with a higher number of delayed discharges. Gaughan et al (2017) examine the impact of local supply of long-term care beds on exits from hospitals for hip fracture and stroke patients in England. They examine how care differs across patients treated in the same hospital but living in different local authorities.…”

Section: Previous Literaturementioning

confidence: 99%

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The impact of cuts to social care spending on the use of Accident and Emergency departments in England

Crawford¹,

Stoye²,

Zaranko³

2018

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Recent years have seen substantial reductions in public spending on social care for older people in England. This has not only led to large falls in the number of people over the age of 65 receiving publicly funded social care, but also to growing concern about the potential knock-on effects on other public services, and in particular the National Health Service (NHS). In this paper, we exploit regional variation in the reductions in public funding for social care to examine the impact on Accident and Emergency (A&E) departments in NHS hospitals. We find that reductions in social care spending on people aged 65 and above have led to increased use of A&E services, both in terms of the average number of visits per resident and the number of unique patients visiting A&E each year. We estimate that the average cut to social care spending for the older population over the period (£375) led to an increase of 0.09 visits per resident, compared to a mean of 0.37 visits in 2009. The effects are most pronounced among people aged 85 and above. This has also led to a modest increase in the cost of providing A&E care, increasing A&E costs by an additional £3 per resident for each £100 cut in social care funding.

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Section: Introductionsupporting

confidence: 52%

Section: Previous Literaturementioning

confidence: 99%

The impact of cuts to social care spending on the use of Accident and Emergency departments in England

Crawford¹,

Stoye²,

Zaranko³

2018

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“…Local issues raised within the two case studies also mirrored broader healthcare system problems that currently affect and constrain NHS Trusts nationally. This includes national AE pressures [57,58] and within hip fracture care, once patients are medically fit for discharge, their hospital length of stay is determined by factors such as local care home supply, which are outside of a hospital's control [59].…”

Section: Below)mentioning

confidence: 99%

The importance of power, context and agency in improving patient experience through a patient and family centred care approach

Ocloo

Goodrich

Tanaka

et al. 2020

Health Res Policy Sys

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Background: Research shows that the way that healthcare staff experience their job impacts on their individual performance, patient experience and outcomes as well as on the performance of organisations. This article builds on this literature by investigating, with multi-disciplinary clinical teams as well as patients and relatives, what factors help or hinder changes designed to improve patient experience. Methods: Qualitative research looking at patient-and family-centred care (PFCC) on two care pathways (stroke and hip fracture) was conducted in England and Wales. A realist approach combined with participatory action research was used to account for the complexity of organisational context and power relations. Multiple methods were used, including documentary analysis, participatory steering groups with staff and patient representatives, observations of the care pathways (n = 7), staff and patient and relative focus groups (n = 8), and hospital staff, patient and PFCC staff interviews (n = 47). Results: Findings highlight multiple factors that support and hinder good patient experiences. Within individual care, paternalistic values and a lack of shared decision-making and patient-centred care still exist. Supportive interdisciplinary teamwork is needed to address issues of hierarchy, power and authority amongst staff and managers. At the organisational level, key issues of waiting times, patient flow, organisational resources and timely discharge affect staff's time and capacity to deliver care. In addition, macro contextual factors, such as finance, policy, targets and measures, set particular limits for improvement projects. Conclusions: Given this context, improving patient experience needs to go well beyond small-scale projects at the micro and meso level to incorporate a more critical understanding of systems, the wider organisational context and how power operates at multiple levels to enable and constrain action. In order to more meaningfully understand and address the factors that can help or hinder activities to improve patient experiences, PFCC frameworks and methods need to account for how power inequities operate and require the adoption of more participatory coproduced and empowering approaches to involve patients, relatives, carers and staff in improving complex healthcare environments.

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“…He outlines that a £1 increase in spending on care homes reduces hospital expenditures by £0.35, which supports a substitutional relationship. Gaughan et al () and Gaughan et al () confirm this relationship by analyzing the influence of the number of available nursing home beds as well as nursing home prices on length of hospital stay. Both papers exploit the context of hospital bed‐blocking in the United Kingdom.…”

Section: Introductionmentioning

confidence: 99%

Do financial incentives influence the hospitalization rate of nursing home residents? Evidence from Germany

Kümpel

2019

Health Economics

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Efficient health‐care provision for nursing home residents is a concern in many OECD (Organization for Economic Cooperation and Development) countries. This paper analyzes whether nursing homes respond to financial incentives when deciding whether to hospitalize their residents. In Germany, reimbursements for nursing homes are reduced after a defined number of days when a resident stays in a hospital instead of a nursing home. As a result of a federal law introduced in 2008, some German states had to change the point at which reimbursements to nursing homes are reduced so that reductions are made from Day 4 instead of Day 1 of a resident's absence. This exogenously raised an incentive for the nursing homes affected to hospitalize residents especially for an expected short‐term stay. This analysis exploits the introduction of the law in a difference‐in‐difference approach, using market‐wide German‐DRG files covering all hospital patients discharged from hospitals to nursing homes from 2007 to 2011. The results suggest an increase of approximately 11% in short‐term hospital stays as a consequence of the longer reimbursement period introduced by the law.

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Long-term care provision, hospital bed blocking, and discharge destination for hip fracture and stroke patients

Cited by 31 publications

References 33 publications

The impact of cuts to social care spending on the use of Accident and Emergency departments in England

The impact of cuts to social care spending on the use of Accident and Emergency departments in England

The importance of power, context and agency in improving patient experience through a patient and family centred care approach

Do financial incentives influence the hospitalization rate of nursing home residents? Evidence from Germany

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