Background

Research studies have shown that older people treated in community hospital wards do better than people treated in general hospitals. However, two national surveys by NHS Benchmarking have shown that measures of community hospital care such as staffing, leadership, lengths of stay, outcomes and costs vary greatly between community hospitals. It is not known why such differences occur, or how they affect the quality of care and costs. There are popular (and possibly cheaper) alternatives to the community hospital ward care such as short-term rehabilitation at home or in residential care homes but differences in results for patients and costs between the types of services are unclear. Our proposed study will address these issues.

Aims & Objectives

The project aims to use two existing data sets (the NHS Benchmarking Community Hospital Project and the National Audit of Intermediate Care) to describe in detail the current and potential performance of community hospital in-patient care for older people.

The objectives of the study are:

  • To measure the current relative performance of community hospital in-patient care for older people (what does current community hospital practice look like?)
  • To identify the characteristics of community hospital in-patient care for older people that optimises performance (what does ‘best’ look like?)
  • To investigate the current impact of community hospital in-patient care for older people on secondary care and the potential impact if the community hospital care was optimised to best practice nationally (What might the effects of “best” look like?)
  • To determine if there is an association between the configurations of short-term, community-based services and reduction in secondary care bed utilisation by older people. (Is there an optimum whole system configuration, and what are the tolerances?)
  • To develop web-based interactive toolkits for use by local commissioners and community hospital teams that support operational changes to optimise performance.

Methods

The objectives will be realised through four inter-linked studies:

Study 1:  Cost efficiency modelling (heath economics study)
Study 2: National community hospital survey (co-produced with the Community Hospital Association)
Study 3:  In depth case studies (quantitative and qualitative study)
Study 4:  Development of web-based quality improvement toolkits

Outputs

Young J, Hulme C, Smith A, Buckell J, Godfrey M, Holditch C, Grantham J, Tucker H, Enderby P, Gladman J, Teale E, Thiebaud JC. Measuring and optimising the efficiency of community hospital inpatient care for older people: the MoCHA mixed-methods study Health Services and Delivery Research 2020;8(1). https://doi.org/10.3310/hsdr08010

Gladman J, Buckell J, Young J. Smith A, Hulme C, Saggu S, Godfrey M, Enderby P, Teale E, Longo R, Gannon B, Holditch C, Eardley H, Tucker H. Understanding the Models of Community Hospital rehabilitation Activity (MoCHA): a mixed method study. BMJ Open 2017;7:e010483. https://doi.org/10.1136/bmjopen-2015-010483

Partners & Collaborators

Investigators

John Young, Mary Godfrey, Elizabeth Teale, Andrew Smith, Roberta Longo, Brenda Gannon, Claire Hulme, Pamela Enderby, Heather Eardley, Claire Holditch, Helen Tucker.

Collaborators
Birmingham University (Prof. Jon Glasby), RAND Europe (Dr Ellen Nolte)

Timescales

July 2014 to June 2017

Funding agency

National Institute for Health and Care Research (NIHR)

Further information

For further information contact Anne Forster

This summary represents independent research funded by the National Institute for Health and Care Research (Health Services and Delivery Research, 12/177/04 – A study to understand and optimise community hospital ward care in the NHS). The views expressed in this publication are those of the author(s) and not necessarily those of the NHS, the National Institute for Health and Care Research or the Department of Health and Social Care