Mansour Mohammad Hussein Housam, Pokhrel Subhash, Birnbaum Maurice, Anokye Nana
Health Sciences, Brunel University London, Uxbridge, UK.
Business Intelligence, North West London Clinical Commissioning Group, London, UK.
Integr Healthc J. 2022 Nov 17;4(1):e000104. doi: 10.1136/ihj-2021-000104. eCollection 2022.
First impact assessment analysis of an integrated care model (ICM) to reduce hospital activity in the London Borough of Hillingdon, UK.
We evaluated a population-based ICM consisting of multiple interventions based on self-management, multidisciplinary teams, case management and discharge management. The sample included 331 330 registered Hillingdon residents (at the time of data extraction) between October 2018 and July 2020. Longitudinal data was extracted from the Whole Systems Integrated Care database. Interrupted time series Poisson and Negative binomial regressions were used to examine changes in non-elective hospital admissions (NEL admissions), accident and emergency visits (A&E) and length of stay (LoS) at the hospital. Multiple imputations were used to replace missing data. Subgroup analysis of various groups with and without long-term conditions (LTC) was also conducted using the same models.
In the whole registered population of Hillingdon at the time of data collection, gradual decline over time in NEL admissions (RR 0.91, 95% CI 0.90 to 0.92), A&E visits (RR 0.94, 95% CI 0.93 to 0.95) and LoS (RR 0.93, 95% CI 0.92 to 0.94) following an immediate increase during the first months of implementation in the three outcomes was observed. Subgroup analysis across different groups, including those with and without LTCs, showed similar effects. Sensitivity analysis did not show a notable change compared with the original analysis.
The Hillingdon ICM showed effectiveness in reducing NEL admissions, A&E visits and LoS. However, further investigations and analyses could confirm the results of this study and rule out the potential effects of some confounding events, such as the emergence of COVID-19 pandemic.
对英国希灵登伦敦自治市的一种综合护理模式（ICM）进行首次影响评估分析，以减少医院业务量。
我们评估了一种基于人群的ICM，其由基于自我管理、多学科团队、病例管理和出院管理的多种干预措施组成。样本包括2018年10月至2020年7月期间希灵登331330名注册居民（在数据提取时）。纵向数据从全系统综合护理数据库中提取。采用中断时间序列泊松回归和负二项回归来检验非择期住院（NEL住院）、急诊就诊（A&E）和住院时间（LoS）的变化。使用多重插补来替代缺失数据。还使用相同模型对有和没有长期病症（LTC）的不同组进行亚组分析。
在数据收集时希灵登的整个注册人群中，观察到在实施的头几个月这三个结果立即增加后，NEL住院（RR 0.91，95%CI 0.90至0.92）、A&E就诊（RR 0.94，95%CI 0.93至0.95）和LoS（RR 0.93，95%CI 0.92至0.94）随时间逐渐下降。包括有和没有LTC的不同组的亚组分析显示了类似的效果。与原始分析相比，敏感性分析未显示出显著变化。
希灵登ICM在减少NEL住院、A&E就诊和LoS方面显示出有效性。然而，进一步的调查和分析可以证实本研究的结果，并排除一些混杂事件的潜在影响，如COVID-19大流行的出现。
