PSSRU, University of Kent, Canterbury, CT2 7NF, UK.
Social Policy Research Unit, Department of Social Policy and Social Work, University of York, York, UK.
BMC Health Serv Res. 2021 Dec 2;21(1):1297. doi: 10.1186/s12913-021-07206-5.
Delayed transfers of care (DTOC) of patients from hospital to alternative care settings are a longstanding problem in England and elsewhere, having negative implications for patient outcomes and costs to health and social care systems. In England, a large proportion of DTOC are attributed to a delay in receiving suitable home care. We estimated the relationship between home care supply and delayed discharges in England from 2011 to 2016.
Reduced form fixed effects OLS models of annual DTOC attributed to social care at local authority (LA)-level from 2011 to 2016 were estimated, using both number of days and patients as the dependent variable. A count of home care providers at LA-level was utilised as the measure of home care supply. Demand (e.g. population, health, income) and alternative supply (e.g. care home places, local unemployment) measures were included as controls. Instrumental Variable (IV) methods were used to control for any simultaneity in the relationship between DTOC and home care supply. Models for DTOC attributed to NHS and awaiting a home care package were used to assess the adequacy of the main model.
We found that home care supply significantly reduced DTOC. Each extra provider per 10 sq. km. in the average local authority decreased DTOC by 14.9% (equivalent to 449 days per year), with a per provider estimate of 1.6% (48 days per year). We estimated cost savings to the public sector over the period of analysis from reduced DTOC due to increased home care provision between £73 m and £274 m (95% CI: £0.24 m to £545.3 m), with a per provider estimate of savings per year of £12,600 (95% CI: £900 to £24,500).
DTOC are reduced in LAs with better supply of home care, and this reduces costs to the NHS. Further savings could be achieved through improved outcomes of people no longer delayed. Appropriate levels of social care supply are required to ensure efficiency in spending for the public sector overall.
在英国和其他国家，患者从医院转移到替代护理环境的延迟（DTOC）是一个长期存在的问题，这对患者的结果和医疗保健系统的成本都有负面影响。在英国，很大一部分 DTOC 是由于未能及时获得合适的家庭护理而导致的。我们评估了 2011 年至 2016 年期间英格兰家庭护理供应与延迟出院之间的关系。
使用 2011 年至 2016 年地方当局（LA）层面社会护理归因于 DTOC 的天数和患者作为因变量，对年度 DTOC 进行简化形式固定效应 OLS 模型估计。利用 LA 层面的家庭护理提供者数量作为家庭护理供应的衡量标准。需求（如人口、健康、收入）和替代供应（如养老院床位、当地失业率）措施被用作控制变量。使用工具变量（IV）方法来控制 DTOC 和家庭护理供应之间的任何同时性关系。还使用 NHS 归因于 DTOC 和等待家庭护理包的模型来评估主要模型的充分性。
我们发现家庭护理供应显著减少了 DTOC。每个平均地方当局每增加 10 平方公里的提供者，减少 DTOC 14.9%（相当于每年减少 449 天），每个提供者的估计值为 1.6%（每年减少 48 天）。我们估计，由于家庭护理供应增加而减少 DTOC，在分析期间为公共部门节省的成本在 7300 万英镑至 2.74 亿英镑之间（95%置信区间：2400 万英镑至 5453 万英镑），每个提供者每年的节省额为 12600 英镑（95%置信区间：900 英镑至 24500 英镑）。
LA 中家庭护理供应更好，DTOC 减少，这降低了 NHS 的成本。通过提高不再延迟的人的结果，可以实现进一步的节省。需要适当水平的社会护理供应，以确保公共部门的支出效率。
