Seamer Paul, Lloyd Therese, Conti Stefano, O'Neill Stephen
The Strategy Unit, NHS Midlands & Lancashire Commissioning Support Unit, Birmingham, UK.
Improvement Analytics Unit, The Health Foundation, London, UK.
Int J Integr Care. 2023 Aug 17;23(3):10. doi: 10.5334/ijic.6475. eCollection 2023 Jul-Sep.
Reducing hospital use is often viewed as a possible positive consequence of introducing integrated care (IC). We investigated the impact of an IC programme in North East Hampshire and Farnham (NEHF), in southern England, on hospital utilisation among older adults over a 55 months period.
We used a Generalised Synthetic Control design to investigate the effect of implementing IC in NEHF between 2015 and 2020. For a range of hospital use outcomes, we estimated the trajectory that each would have followed in the absence of IC and compared it with the actual trajectory to estimate the potential impact of IC.
Three years into the programme, emergency admission rates started reducing in NEHF relative to its synthetic control, particularly those resulting in overnight hospital stays. By year 5 of the study overall emergency admission rates were 9.8% lower (95% confidence interval: -17.2% to -0.6%). We found no sustained difference in rates of emergency department (ED) visits, and average length of hospital stay was significantly higher from year 2.
An IC programme in NEHF led to lower than estimated emergency admission rates; however, the interpretation of the impact of IC on admissions is complicated as lower rates did not appear until three years into the programme and the reliability of the synthetic control weakens over a long time horizon. There was no sustained change in ED visit rates.
减少医院使用通常被视为引入综合护理（IC）可能产生的积极结果。我们调查了英格兰南部东北汉普郡和法纳姆（NEHF）的一项IC项目在55个月期间对老年人医院利用率的影响。
我们采用广义合成对照设计来研究2015年至2020年在NEHF实施IC的效果。对于一系列医院使用结果，我们估计了在没有IC的情况下每个结果会遵循的轨迹，并将其与实际轨迹进行比较，以估计IC的潜在影响。
该项目开展三年后，NEHF的急诊入院率相对于其合成对照开始下降，尤其是那些导致过夜住院的急诊入院率。到研究的第5年，总体急诊入院率降低了9.8%（95%置信区间：-17.2%至-0.6%）。我们发现急诊就诊率没有持续差异，并且从第2年起住院平均时长显著增加。
NEHF的一项IC项目导致急诊入院率低于预期；然而，由于直到该项目开展三年后入院率才出现下降，且合成对照在较长时间范围内的可靠性减弱，因此对IC对入院率影响的解释较为复杂。急诊就诊率没有持续变化。
