Please use this identifier to cite or link to this item:
|Title: ||Establishing and implementing best practice to reduce unplanned admissions in those aged 85 years and over through system change [Establishing System Change for Admissions of People 85+ (ESCAPE 85+)]: a mixed-methods case study approach|
|Authors: ||Wilson, Andrew|
Bhamra, Ran S.
|Issue Date: ||2015|
|Publisher: ||NIHR Journals Library / © Queens Printer and Controller HMSO|
|Citation: ||WILSON, A. ... et al, 2015. Establishing and implementing best practice to reduce unplanned admissions in those aged 85 years and over through system change [Establishing System Change for Admissions of People 85+ (ESCAPE 85+)]: a mixed-methods case study approach. Health Services and Delivery Research, 3 (37).|
|Abstract: ||Background: In England, between 2007/8 and 2009/10, the rate of unplanned hospital admissions of
people aged 85 years and above rose from 48 to 52 per 100. There was substantial variation, with some
areas showing a much faster rate of increase and others showing a decline.
Objectives: To identify system characteristics associated with higher and lower increases in unplanned
admission rates in those aged 85 years and over; to develop recommendations to inform providers and
commissioners; and to investigate the challenges of starting to implement these recommendations.
Design: Mixed-methods study using routinely collected data, in-depth interviews and focus groups.
Data were analysed using the framework approach, with themes following McKinsey’s 7S model.
Recommendations derived from our findings were refined and prioritised through respondent validation
and consultation with the project steering group. The process of beginning to implement these
recommendations was examined in one ‘implementation site’.
Participants: Six study sites were selected based on admission data for patients aged 85 years and above
from primary care trusts: three where rates of increase were among the most rapid and three where they
had slowed down or declined. Each ‘improving’ or ‘deteriorating’ site comprised an acute hospital trust, its
linked primary care trust/clinical commissioning group, the provider of community health services, and
adult social care. At each site, representatives from these organisations at strategic and operational levels,
as well as representatives of patient groups, were interviewed to understand how policies had been
developed and implemented. A total of 142 respondents were interviewed. Results: Between 2007/8 and 2009/10, average admission rates for people aged 85 years and over rose
by 5.5% annually in deteriorating sites and fell by 1% annually in improving sites. During the period
under examination, the population aged 85 years and over in deteriorating sites increased by 3.4%,
compared with 1.3% in improving sites. In deteriorating sites, there were problems with general
practitioner access, pressures on emergency departments and a lack of community-based alternatives to
admission. However, the most striking difference between improving and deteriorating sites was not the
presence or absence of specific services, but the extent to which integration within and between types of
service had been achieved. There were also overwhelming differences in leadership, culture and strategic
development at the system level. The final list of recommendations emphasises the importance of issues
such as maximising integration of services, strategic leadership and adopting a system-wide approach
Conclusions: Rising admission rates for older people were seen in places where several parts of the system
were under strain. Places which had stemmed the rising tide of admissions had done so through strong,
stable leadership, a shared vision and strategy, and common values across the system.
Future work: Research on individual components of care for older people needs to take account of their
impact on the system as a whole. Areas where more evidence is needed include the impact of improving
access and continuity in primary care, the optimal capacity for intermediate care and how the frail elderly
can best be managed in emergency departments.|
|Description: ||© Queen’s Printer and Controller of HMSO 2015. This work was produced by Wilson et al. under the terms of a commissioning
contract issued by the Secretary of State for Health. This issue may be freely reproduced for the purposes of private research and
study and extracts (or indeed, the full report) may be included in professional journals provided that suitable acknowledgement
is made and the reproduction is not associated with any form of advertising. Applications for commercial reproduction should be
addressed to: NIHR Journals Library, National Institute for Health Research, Evaluation, Trials and Studies Coordinating Centre,
Alpha House, University of Southampton Science Park, Southampton SO16 7NS, UK.|
|Sponsor: ||The research reported in this issue of the journal was funded by the HS&DR programme or one of its preceding programmes as project
|Publisher Link: ||http://dx.doi.org/10.3310/hsdr03370|
|Appears in Collections:||Published Articles (Mechanical, Electrical and Manufacturing Engineering)|
Files associated with this item:
Items in DSpace are protected by copyright, with all rights reserved, unless otherwise indicated.