Elston Julian, Gradinger Felix, Asthana Sheena, Fox Matthew, Dawson Louise, Butler Dawn, Byng Richard
Community and Primary Care Research Group (Faculty of Health), Plymouth University, UK.
Plymouth Institute of Health and Care Research (PIHR), Plymouth University, UK.
Int J Integr Care. 2022 Feb 14;22(1):14. doi: 10.5334/ijic.5665. eCollection 2022 Jan-Mar.
Intermediate care (IC) was redesigned to manage more complex, older patients in the community, avoid admissions and facilitate earlier hospital discharge. The service was 'enhanced' by employing GPs, pharmacists and the voluntary sector to be part of a daily interdisciplinary team meeting, working alongside social workers and community staff (the traditional model).
A controlled before-and-after study, using mixed methods and a nested case study. Enhanced IC in one locality (Coastal) is compared with four other localities where IC was not enhanced until the following year (controls), using system-wide performance data (N = 4,048) together with data collected on referral-type, staff inputs and patient experience (N = 72).
Coastal showed statistically significant increase in EIC referrals to 11.6% (95%CI: 10.8%-12.4%), with a growing proportion from GPs (2.9%, 95%CI: 2.5%-3.3%); more people being cared for at home (10.5%, 95%CI: 9.8%-11.2%), shorter episode lengths (9.0 days, CI 95%: 7.6-10.4 days) and lower bed-day rates in ≥70 year-olds (0.17, 95%CI: 0.179-0.161). The nested case study showed medical, pharmacist and voluntary sector input into cases, a more holistic, coordinated service focused on patient priorities and reduced acute hospital admissions (5.5%).
Enhancing IC through greater acute, primary care and voluntary sector integration can lead to more complex, older patients being managed in the community, with modest impacts on service efficiency, system activity, and notional costs off-set by perceived benefits.
中级护理（IC）进行了重新设计，以管理社区中更复杂的老年患者，避免住院并促进更早出院。通过聘请全科医生、药剂师和志愿部门参与每日跨学科团队会议，与社会工作者和社区工作人员一起工作（传统模式），该服务得到了“强化”。
采用前后对照研究，运用混合方法和嵌套案例研究。将一个地区（沿海地区）的强化中级护理与其他四个直到次年才强化中级护理的地区（对照组）进行比较，使用全系统绩效数据（N = 4,048）以及收集的关于转诊类型、工作人员投入和患者体验的数据（N = 72）。
沿海地区强化中级护理的转诊率在统计学上显著增加至11.6%（95%置信区间：10.8% - 12.4%），来自全科医生的转诊比例不断上升（2.9%，95%置信区间：2.5% - 3.3%）；更多人在家中接受护理（10.5%，95%置信区间：9.8% - 11.2%），病程缩短（9.0天，95%置信区间：7.6 - 10.4天），70岁及以上患者的床日率降低（0.17，95%置信区间：0.179 - 0.161）。嵌套案例研究表明，医疗、药剂师和志愿部门参与病例管理，提供了更全面、协调的服务，以患者优先事项为重点，并减少了急性医院入院（5.5%）。
通过加强急性、初级护理和志愿部门的整合来强化中级护理，可以使社区中更复杂的老年患者得到管理，对服务效率、系统活动有适度影响，且感知到的益处可抵消名义成本。
