Beech Roger, Russell Wanda, Little Richard, Sherlow-Jones Sally
Centre for Health Planning and Management, Keele University, UK.
Int J Integr Care. 2004;4:e02. doi: 10.5334/ijic.113. Epub 2004 Oct 4.
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.
A mixed-method descriptive design using quantitative and qualitative techniques was used to monitor: the characteristics of service users, the types and amounts of care received, any 'adverse' events arising from that care, and the acceptability of the service to patients and carers. A collaborative approach involving key stakeholders allowed appropriate data to be gathered from patient case notes, RRT staff, local health and social care providers, and patients and their carers. A suite of self-completed questionnaires was, therefore, designed to capture study data on patients and activities of care, and workshops and semi-structured interview schedules used to obtain feedback from users and stakeholders.
Service users (231) were elderly (mean age 75.9), from three main diagnostic categories (respiratory conditions 19.0%, heart/stroke 16.2%, falls 13.4%), with the majority (57.0%) having both medical and social care needs. All patients received care at home (mean duration 5.6 days) with only 5.7% of patients having to be re-admitted to acute care. Overall, patients and carers had positive attitudes to the new service but some expressed concerns about their ability to influence the choice of care option (24.1% and 25.0% of patients and carers, respectively), whilst 22.7% of carers were concerned about the quality of information about care.
Both the nature of schemes for intermediate care, and the policy context in which they are introduced, mean that pragmatic methodologies are often required to evaluate their impacts. Unfortunately, this need for pragmatism can then mean that it is difficult to reach definitive conclusions about the merits of schemes. However, the findings of this evaluation suggest that the Rapid Response Team provided an 'acceptable' alternative to an extended period of care in an acute setting. Such schemes may have relevance beyond the NHS of the UK as a means of providing a more appropriate and cost efficient match between patients' needs for care, the types of care provided, and the place in which care is provided.
英国国家医疗服务计划的实施将使中级护理服务得到扩展。此类服务通常针对老年人，旨在：防止“可避免的”急性住院护理入院情况；促进患者从急性住院护理中及时出院；推动患者康复。一系列服务可能都属于中级护理范畴。它们通常在患者家中或非急性机构提供。本文描述了对一个多学科快速反应团队（RRT）的评估。该服务旨在为患者提供一种居家护理选择，以替代此前在急性医院病床接受的护理，这种选择为患者及其护理者所接受，并维持临床护理标准。该服务面向位于英格兰中部的一个乡村小镇赫里福德的居民提供。
采用定量和定性技术相结合的混合方法描述性设计，以监测：服务使用者的特征、接受的护理类型和数量、该护理引发的任何“不良”事件，以及该服务对患者及其护理者的可接受性。一种涉及关键利益相关者的协作方法使得能够从患者病历、快速反应团队工作人员、当地卫生和社会护理提供者以及患者及其护理者那里收集到适当的数据。因此，设计了一套自我填写的问卷来收集关于患者和护理活动的研究数据，并通过研讨会和半结构化访谈提纲来获取使用者和利益相关者的反馈。
服务使用者（231人）年龄较大（平均年龄75.9岁），来自三个主要诊断类别（呼吸系统疾病19.0%、心脏/中风16.2%、跌倒13.4%），大多数（57.0%）同时有医疗和社会护理需求。所有患者都在家中接受护理（平均时长5.6天），只有5.7%的患者不得不再次入住急性护理机构。总体而言，患者及其护理者对这项新服务持积极态度，但一些人对他们影响护理选项选择的能力表示担忧（分别有24.１%的患者和25.0%的护理者），同时22.7%的护理者担心护理信息的质量。
中级护理计划的性质及其引入的政策背景意味着，通常需要采用务实的方法来评估其影响。不幸的是，这种务实的需求可能意味着难以就这些计划是否可取得出明确结论。然而，本次评估的结果表明，快速反应团队为在急性环境中延长护理时间提供了一种“可接受的”替代方案。作为一种在患者护理需求、所提供的护理类型以及护理提供地点之间实现更合适且成本效益更高匹配的手段，此类计划可能在英国国家医疗服务体系之外也具有相关性。
