Advertisement

The Reshaping Care for Older People programme and changes in unscheduled hospital care: Analysis of routinely collected hospital data

      Highlights

      • The Scottish Government devised the Reshaping Care for Older People programme.
      • The rate of older people’s emergency admissions to hospital fell during the course of the programme.
      • Alongside this, this study describes increases in mean length of stay.
      • Overall, however, the number of emergency bed days reduced.
      • These reductions were seen across all quintiles of deprivation.

      Abstract

      Objective

      This study examines mean length of stay (LOS) and rates of emergency bed days during the course of the Reshaping Care for Older People (RCOP) programme in Glasgow City.

      Methods

      An ecological small-area study design was used. Standardised monthly rates of bed days and LOS were calculated, between April 2011 and March 2015, for residents of Glasgow City aged 65 years and over. Multilevel negative binomial models for the square root of each outcome nested by datazone were created, adjusting for sex, 5-year age group, area-level deprivation, season, month and month squared. Relative index of inequality (RII) and slope index of inequality (SII) were calculated for each year and the trend was examined.

      Results

      The rate of bed days first rose then fell during the study period, while LOS first fell then rose. Relative risk (RR) of an additional bed day was greater for males (RR = 1.14 (1.12, 1.16)) and increased with increasing age group. There was no gender difference in LOS. Bed days per head of population first increased then fell; for 12-month period RR = 1.01 (0.98, 1.05) and for 12-month period squared, RR = 0.999 (0.999, 0.999). RII and SII for rate of bed days per head of population were significant, though not for LOS. SII for bed days per head of population did not change significantly over time, while RII reduced at the 87% level of confidence.

      Conclusions

      The results suggest a reduction in secondary care use by older people during the RCOP programme, and a possible reduction in socioeconomic inequalities in bed days in the longer term.

      Keywords

      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to Maturitas
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

        • COSLA
        • Scottish Government and NHS Scotland
        Reshaping Care for Older People: A Programme for Change 2011–2021.
        Scottish Government, Edinburgh2011
        • Harding O.
        • Hay L.
        • Mackie P.
        Health and Social Care Needs of Older People in Scotland: An Epidemiological Assessment.
        Scottish Public Health Network (ScotPHN), Glasgow2013
        • Kendrick S.
        • Conway M.
        Increasing Emergency Admissions Among Older People in Scotland: A Whole System Account. Whole Systems Project Working Paper 1.
        NHS Information and Statistics Division, Edinburgh2003
        • Blunt I.
        • Bardsley M.
        • Dixon J.
        Trends in Emergency Admissions in England 2004–2009: Is Greater Efficiency Breeding Inefficiency?.
        Nuffield Trust, London2010
        • Wittenberg R.
        • Sharpin L.
        • McCormick B.
        • Hurst J.
        Understanding Emergency Hospital Admission of Older People.
        Centre for Health Service Economics and Organisation, Oxford2014 (http://eprints.lse.ac.uk/60622/ (Accessed 25 February 2017))
        • Imison C.
        • Poteliakhoff E.
        • Thompson J.
        Older People and Emergency Bed Use: Exploring Variation.
        King’s Fund, London2012
        • Poteliakhoff E.
        • Thompson J.
        Data Briefing Emergency Bed Use: What the Numbers Tell Us.
        King’s Fund, London2011
        • Brown A.M.
        • Cleland J.G.F.
        Influence of concomitant disease on patterns of hospitalization in patients with heart failure discharged from Scottish hospitals in 1995.
        Eur. Heart J. 1998; 19: 1063-1069
        • Kjekshus L.E.
        Primary health care and hospital interactions: effects for hospital length of stay.
        Scand. J. Public Health. 2005; 33: 114-122
        • Rosenthal G.E.
        • Harper D.L.
        • Quinn L.M.
        • Cooper G.S.
        Severity-adjusted mortality and length of stay in teaching and nonteaching hospitals: results of a regional study.
        J. Am. Med. Assoc. 1997; 278: 485-490
        • Wright S.P.
        • Verouhis D.
        • Gamble G.
        • Swedberg K.
        • Sharpe N.
        • Doughty R.N.
        Factors influencing the length of hospital stay of patients with heart failure.
        Eur. J. Heart Fail. 2003; 5: 201-209
        • Salonga-Reyes A.
        • Scott I.A.
        Stranded: causes and effects of discharge delays involving non-acute in-patients requiring maintenance care in a tertiary hospital general medicine service, Aust.
        Health Rev . 2016; 41: 54-62
        • Levin K.A.
        • Crighton E.M.
        Reshaping Care for Older People: trends in emergency admissions to hospital during a period of simultaneous interventions in Glasgow City, April 2011–March 2015.
        Maturitas. 2016; 94: 92-97
        • Scottish Government
        SIMD.
        2012 (http://simd.scotland.gov.uk/publication-2012/ (Accessed 25 February 2017))
        • Rasbash J.
        • Charlton C.
        • Browne W.J.
        • Healy M.
        • Cameron B.
        MLwiN Version 2.1.
        Centre for Multilevel Modelling, Bristol2009
        • Yau K.K.
        • Wang K.
        • Lee A.H.
        Zero-inflated negative binomial mixed regression modeling of over-dispersed count data with extra zeros.
        Biom. J. 2003; 45: 437-452
        • Regidor E.
        Measures of health inequalities: part 2.
        J. Epidemiol. Community Health. 2004; 58: 900-903
        • OECD
        Health at a Glance 2015: OECD Indicators.
        OECD Publishing, Paris2015
        • Heggestad T.
        Do hospital length of stay and staffing ratio affect elderly patients' risk of readmission? A nation-wide study of Norwegian hospitals.
        Health Serv. Res. 2002; 37: 647-665
        • Kaboli P.J.
        • Go J.T.
        • Hockenberry J.
        • Glasgow J.M.
        • Johnson S.R.
        • Rosenthal G.E.
        • Jones M.P.
        • Vaughan-Sarrazin M.
        Associations between reduced hospital length of stay and 30-day readmission rate and mortality: 14-year experience in 129 Veterans Affairs hospitals.
        Ann. Intern. Med. 2012; 157: 837-845
        • Roland M.
        • Abel G.
        Reducing emergency admissions: are we on the right track?.
        BMJ. 2012; 345: e6017
        • Scottish Government
        Accident and Emergency Waiting Times.
        Scottish Government, Edinburgh2016 (http://www.gov.scot/About/Performance/scotPerforms/NHSScotlandperformance/AE-LDP (accessed 25.02.17))
        • Morse A.
        Emergency Admissions to Hospital: Managing the Demand.
        The Stationery Office, National Audit Office, London2013
        • Wright P.N.
        • Tan G.
        • Iliffe S.
        • Lee D.
        The impact of a new emergency admission avoidance system for older people on length of stay and same-day discharges.
        Age Ageing. 2014; 43: 116-121
        • White M.
        • Adams J.
        • Heywood P.
        How and why do interventions that increase health overall widen inequalities within populations.
        in: Babones S.J. Social Inequality and Public Health. Policy Press, Bristol2009: 65-82
        • Bernal J.L.
        • Cummins S.
        • Gasparrini A.
        2016. Interrupted time series regression for the evaluation of public health interventions: a tutorial.
        Int. J. Epidemiol. 2017; 1: 348-355
      1. K.A. Levin, J. Carson, E. Crighton, Measuring the impact of a public awareness campaign to increase Welfare Power of Attorney registrations in Scotland, Age Ageing, in press. https://academic.oup.com/ageing/article-abstract/doi/10.1093/ageing/afw249/2926035/Measuring-the-impact-of-a-public.