Diversity in intermediate care (original) (raw)
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This paper reports the results of a postal survey of intermediate care co-ordinators (ICCs) on the organization and delivery of intermediate care services for older people in England, conducted between November 2003 and May 2004. Questionnaires, which covered a range of issues with a variety of quantitative, ‘tick-box’ and open-ended questions, were returned by 106 respondents, representing just over 35% of primary care trusts (PCTs). We discuss the role of ICCs, the integration of local systems of intermediate care provision, and the form, function and model of delivery of services described by respondents. Using descriptive and statistical analysis of the responses, we highlight in particular the relationship between provision of admission avoidance and supported discharge, the availability of 24-hour care, and the locations in which care is provided, and relate our findings to the emerging evidence base for intermediate care, guidance on implementation from central government, and debate in the literature. Whilst the expansion and integration of intermediate care appear to be continuing apace, much provision seems concentrated in supported discharge services rather than acute admission avoidance, and particularly in residential forms of post-acute intermediate care. Supported discharge services tend to be found in residential settings, while admission avoidance provision tends to be non-residential in nature. Twenty-four hour care in non-residential settings is not available in several responding PCTs. These findings raise questions about the relationship between the implementation of intermediate care and the evidence for and aims of the policy as part of NHS modernization, and the extent to which intermediate care represents a genuinely novel approach to the care and rehabilitation of older people.
Providing effective and preferred care closer to home: a realist review of intermediate care
Health & Social Care in the Community, 2015
Intermediate care is one of a number of service delivery models intended to integrate care and provide enhanced health and social care services closer to home, especially to reduce reliance on acute care hospital beds. In order for health and social care practitioners, service managers and commissioners to make informed decisions, it is vital to understand how to implement the admission avoidance and early supported discharge components of intermediate care within the context of local care systems. This paper reports the findings of a theory-driven (realist) review conducted in 2011-12. A broad range of evidence contained in 193 sources was used to construct a conceptual framework for intermediate care. This framework forms the basis for exploring factors at service-user, professional, and organisational levels that should be considered when designing and delivering intermediate care services within a particular local context. Our synthesis found that involving service users and their carers in collaborative decision-making about the objectives of care and the place of care is central to achieving the aims of intermediate care. This pivotal involvement of the service user relies on practitioners, service managers, and commissioners being aware of the impact that organisational structures at the local level can have on enabling or inhibiting collaborative decision making and care coordination. Through all interactions with service users and their care networks, health and social care professionals should establish the meaning which alternative care environments have for different service users. Doing so means decisions about the best place of care will be better informed and gives service users choice. This in turn is likely to support psychological and social stability, and the attainment of functional goals. At an organisational level, integrated working can facilitate the delivery of intermediate care, but there is not a straightforward relationship between integrated organisational processes and integrated professional practice.
International Journal of Integrated Care, 2019
organisation (ico) in torbay and south devon, uk Coastal EIC had persistently shorter LOS, lower bed-day and emergency attendance rates and more care at home than other localities, but fluctuations over time weaken attribution solely to EIC. Discussion: Coastal EIC was managing more complex patients in the community. Greater clinical and pharmaceutical input and personal information at the daily MDT, record sharing and pro-active links with GPs and the hospital, enabled more PCCC, impacting on LOS and demand. Conclusion: EIC has the potential to deliver better patient experience for complex, older patients, whilst reducing demand and costs. Lessons learned: Implementing EIC consistently across localities presented challenges for leadership, GP engagement, record sharing, and links with community and acute services. RiRs can help facilitate relationships, learning and service development. Limitations: Implementing complex integrated interventions often precludes rigorous study designs. Although case studies and participatory research are prone to bias, they can provide rich insights and support change. Suggestions for future research: How can the RiR model support implementation of other complex integrated care initiatives?
A whole system study of intermediate care services for older people
Age and Ageing, 2005
Background: intermediate care (IC) services have been widely introduced in England and have the strategic objectives of reducing hospital and long-term care use. There is uncertainty about the clinical outcomes of these services and whether their strategic aims will be realised. Setting: a metropolitan city in northern England. Design: a quasi-experimental study comparing a group of older people before and after the introduction of an IC service. A quota sampling method was used to match the groups. Subjects: patients presenting as emergency admissions to two elderly care departments with falls, confusion, incontinence or immobility. Intervention: a city-wide service in which a joint care management team (multi-agency, multidisciplinary) assessed patient need and purchased support and rehabilitation from sector-based IC teams. Outcomes: Nottingham Extended Activities of Daily Living score, Barthel Index, Hospital Anxiety and Depression score, mortality, readmission to hospital, and new institutional care placement at 3, 6 and 12 months post-recruitment. Results: there were 800 and 848 patients, respectively, in the control and intervention groups. Clinical outcomes, hospital and long-term care use were similar between the groups. Uptake of IC was lower than anticipated at 29%. An embedded case-control study comparing the 246 patients who received IC with a matched sample from the control group demonstrated similar clinical outcomes but increased hospital bed days used over 12 months (mean +8 days; 95% CI 3.1-13.0). Conclusion: this city-wide IC service was associated with similar clinical outcomes but did not achieve its strategic objectives of reducing long-term care and hospital use.
An evaluation of a multidisciplinary team for intermediate care at home
International journal of integrated care, 2004
The implementation of the National Health Service Plan for the UK will see an expansion of services for intermediate care. Such services are usually targeted at older people and aim to: prevent 'avoidable' admissions to acute inpatient care; facilitate the timely discharge of patients from acute inpatient care; promote patient rehabilitation. A range of services might fall under the banner of intermediate care. They are usually delivered in patients' homes or in non-acute institutions. This paper describes an evaluation of a multidisciplinary Rapid Response Team (RRT). This service aimed to provide a home based alternative to care previously provided in an acute hospital bed which was acceptable to patients and carers and which maintained clinical care standards. The service was provided for the population of Hereford, a rural town in the middle of England.
Implementing a step down intermediate care service
Journal of Integrated Care, 2019
Purpose The purpose of this paper is to explore implementation and development of step-down intermediate care (IC) in Glasgow City from the perspective of staff. Design/methodology/approach The study used qualitative methods. Nine key members of staff were interviewed and three focus groups were run for social work, rehabilitation and care home staff. Framework analysis was used to identify common themes. Findings The proposed benefits of IC were supported anecdotally by staff. Perceived enablers included: having a range of engaged stakeholders, strong leadership and a risk management system in place, good relationships, trust and communication between agencies, a discharge target, training of staff, changing perception of risk and risk aversion, the right infrastructure and staffing, an accommodation-based strategy for patients discharged from IC, the right context of political priorities, funding and ongoing adaptation of the model in discussion with frontline staff. Potential imp...
Implementing an integrated acute response service: professional perceptions of intermediate care
Journal of Integrated Care, 2020
PurposeThe purpose of this study is to examine the implementation, care processes and sustainability of an integrated, intermediate Acute Response Team (ART) service. The primary aims of the service are to enhance the level of health and social care integration across a range of organisations, to ensure a timelier and appropriate service for people in the community at risk of admission to hospital.Design/methodology/approachA qualitative methodology was employed in order to gain a deep understanding of the experiences of staff members within the ART service and external stakeholders. Twenty-one professionals took part in a focus group or one-to-one interviews. Data were analysed thematically.FindingsThe key to successful implementation was that the service was co-created from the “ground-up” with support from local provider organisations. The inclusion of general practitioners (GPs) as part of the team was instrumental in setting up and maintaining the service and seems to be unique...