Title: A study to understand and optimise community hospital ward care in the NHS
Funder: Department of Health (England)

Abstract: Considerable information describing the contemporary community hospital is available from two NHS Benchmarking surveys (180 community hospitals). Two findings are prominent. Firstly the core function of the contemporary community hospital is in-patient care of older people. Secondly large differences are observed in key measures such as bed provision per weighted population clinical leadership waiting times length of stay cost per admission and cost per day. The reasons for such variations are unclear. We propose to investigate these issues by using the existing data sets in combination with a series of linked in-depth studies so that the performance features of community hospital ward care can be understood. Performance will be quantified by modelling cost-efficiency. The model functions of interest include provider and ward organisation features; clinical and service level outcomes; patient experience; types of patient care; and costs. Our focus will be on analysing and describing community hospital ward care as applied to older people that is slow medium and high intensity rehabilitation and end of life care. The National Audit of Intermediate Care (2013) has been modified to support this work. The data sets will also include alternatives to community hospital ward care ie care home rehabilitation; home-based rehabilitation; and social service enablement. We therefore have the opportunity to conduct large scale between-service comparisons and to assess the whole system impact of community based rehabilitation services for older people on secondary care provision. Our study objectives are:1.To measure the current relative performance of community hospital in-patient care for older people (what does current community hospital practice look like? – Study 1).2.To identify the characteristics of community hospital in-patient care for older people that optimises performance (what does ‘best’ look like? – Study 1 and Study 2).3.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? Study 1).4.To determine if there is an association between the configuration (capacity and proportions) of short-term community-based services (i.e. community hospital wards home-based rehabilitation care home rehabilitation and enabling services) and reduction in secondary care bed utilisation by older people. (Is there an optimum whole system configuration and what are the tolerances? Study 1).5.To develop web-based interactive toolkits for use by local commissioners and community hospital teams that support operational changes to optimise performance (Study 4).These objectives will be realised through four inter-linked sequential studies:Study 1: Cost efficiency modelling (Heath economics study)Study 2: National community hospital surveyStudy 3: In-depth case studiesStudy 4: Quality improvement toolkit developmentThe co-applicants comprise a team of health economists led by Claire Hulme; The Patients Association (led by Heather Eardley); the Community Hospitals Association (led by Helen Tucker); a social scientist with experience in older people’s services (Mary Godfrey) and academic clinicians with experience in community hospital care (John Young; John Gladman; Elizabeth Teale; Pam Enderby


Research activity codes: 8.1 ORGANISATION AND DELIVERY OF SERVICES;7.3 MANAGEMENT AND DECISION MAKING
Health categories: GENERIC HEALTH RELEVANCE