Shifting care from hospitals to the community: a review of the evidence on quality and efficiency

Sibbald, Bonnie; McDonald, Ruth; Roland, Martin

doi:10.1258/135581907780279611

Cited by 89 publications

(86 citation statements)

References 10 publications

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“…6 There are also concerns about the perceived high costs of hospital care and, consequently, health-care systems have been experimenting with new ways of shifting specialist services from hospital into the community as a means to increase the accessibility of services and responsiveness of the system, and, potentially, to reduce costs. 20,105,106 In England, a policy focus on moving health care closer to people's homes has led to renewed interest in community hospitals and the potential role they can have in delivering more integrated care at the local level. 18 Countries such as Italy and Norway are implementing community hospital-type delivery models in an effort to reduce reliance on acute hospital care and to provide more integrated care within the community.…”

Section: Introductionmentioning

confidence: 99%

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: Introductionmentioning

confidence: 99%

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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“…5 As GPs will be assuming a key role in commissioning health services in England, there is a clear opportunity to re-model care delivery to maximize outcomes, cost efficiency and patient access by focusing on diseases that are most amenable to management in primary care. 6,7 It is essential that there is evidence to inform what conditions are most sensitive to management in primary care -commonly referred to as primary care sensitive conditions (PCSCs) or ambulatory care sensitive conditions (ACSCs). Such definitions would aid resource planning, drafting of local management protocols and simplification of the interface between primary and secondary care for a number of chronic conditions.…”

mentioning

confidence: 99%

Defining primary care sensitive conditions: a necessity for effective primary care delivery?

et al. 2012

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SummaryPrimary care is a major component of England's National Health Service (NHS), responsible for approximately 300 million consultations per year with GPs in England, which represents 70 -90% of all patient contacts with the NHS. In addition to providing healthcare to the registered population, GPs are charged with coordination and gatekeeping of access to services provided by secondary care, tertiary care and other allied healthcare providers. As GPs will be assuming a key role in commissioning health services in England, there is a clear opportunity to re-model care delivery to maximize outcomes, cost efficiency and patient access by focusing on diseases that are most amenable to management in primary care. It is essential that there is evidence to inform what conditions are most sensitive to management in primary care -commonly referred to as primary care sensitive conditions or ambulatory care sensitive conditions. Such definitions would aid resource planning, drafting of local management protocols and simplification of the interface between primary and secondary care for a number of chronic conditions. Indeed, inappropriate utilization of secondary care resources is likely to represent a significant opportunity cost to healthcare providers and may be less desirable for patients.Primary care is a major component of England's National Health Service (NHS), responsible for approximately 300 million consultations per year with general practitioners (GPs) in England, 1 which represents 70-90% of all patient contacts with the NHS.2 In addition to providing healthcare to the registered population, GPs are charged with coordination and gatekeeping of access to services provided by secondary care, tertiary care and other allied healthcare providers.While primary care has a role to play in the management of acute conditions, there are a number of alternative means by which individuals can directly access appropriate advice and care for acute problems via services such as NHS Direct, Walk-in Centres and Accident & Emergency Departments. In contrast, the management of chronic conditions generally lies within the remit of GPs, and patients are usually only able to obtain ongoing specialist care for their condition if referred to a specialist by their GP.Primary care consultation rates in England are rising year-on-year, 1 and the role of primary careThis is the second article in a series on health policy DECLARATIONS Competing interestsNone declared

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“…A recent review of the evidence base for shifting specialist care from hospitals to the community 12 considered the risks and potential benefits of three models of working that are relevant to mental health input into a polyclinic:…”

Section: Different Modelsmentioning

confidence: 99%

“…13 However, this is less efficient not only in terms of staff travelling time but also in utilising time effectively related to patient nonattendance. 12 In its own right it also does not improve communication with primary care staff. Consultants in general psychiatry have operated such clinics in peripheral parts of their 'patch' for many years.…”

Section: Shifting Mental Health Services Into the Polyclinicmentioning

confidence: 99%

Polyclinics and psychiatry: risks and opportunities

2010

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SummaryThe arrival of the ‘polyclinic’ or ‘GP-led health centre’ has been signalled in the review of the National Health Service. A variety of options have been proposed for the way in which polyclinics will incorporate specialist services to work alongside primary care, and the relevance of these models to mental healthcare is considered. Polyclinics provide new opportunities but with those possibilities come potential threats and risks. Of key importance is the threat that they will re-institutionalise mental healthcare after many years of breaking down such barriers. Buildings provide shared space, but new working practices are more difficult to achieve.

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Shifting care from hospitals to the community: a review of the evidence on quality and efficiency

Abstract: Our findings suggest that the policy may be effective in improving access to specialist care for patients and reducing demand on acute hospitals. There is a risk, however, that the quality of care may decline and costs may increase.

Cited by 89 publications

References 10 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

Defining primary care sensitive conditions: a necessity for effective primary care delivery?

Polyclinics and psychiatry: risks and opportunities

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