Title: New care home admission after hospitalisation - understanding trajectories and predictors using linked health and social care data
Funder: Dunhill Medical Trust

Abstract: Introduction: When used appropriately, admission to a care-home makes a positive contribution to the care landscape, offering best care to individuals who require this level of support and reducing demand on healthcare systems (Bockerman et al., 2012; Spiers et al., 2018). However, use of care varies eight-fold across England and Wales (Audit Commission, 2011). Underpinning this is significant variation in the percentage of older adults admitted to hospital from home who are discharged to a care-home – ranging from 0.14% of admissions to 4.61% (Audit Commission, 2011). The reasons for these variations have not been explored but suggest potential for improvement. NICE guidance states: “ensure that people do not have to make decisions about long-term residential or nursing care while they are in a crisis” (National Institute for Health and Care Excellence, 2015). Data linkage offers the potential to enhance the information available in single data sources and explore complexity in everyday practice (Steventon and Roberts, 2012). Unlinked analysis of the Scottish Care-Home Census (SCHC) provides new insights into this difficult-to-research population and demonstrates the feasibility of using this data source (Burton et al., 2019). Aims: To describe the characteristics, outcomes and costs of moving into a care-home from hospital, compared with from the community and to characterise the variation between regions in proportions moving into care-homes from hospital and from the community Methods: The SCHC contains national data, submitted by care-homes summarising activity over the preceding year and individual level data on long-stay residents (Information Services Division Scotland and NHS National Services Scotland, 2016). There are no comparable national social-care datasets available in England (NHS Digital, 2019). We have created an anonymised linked dataset, based on the SCHC, allowing descriptive epidemiology on those moving into care-homes from hospital, compared with those moving in from home. This dataset includes hospital admissions and secondary care use, long-term conditions and psychoactive medication use for three years prior to moving to the care-home. It will be used to identify predictors of admission; outcomes after admission, calculate costs and identify geographical variations in practice. Importance: This project will provide an exemplar of the potential of linked health and social-care data in exploring real-world practice, develop analytical understanding and insights into the organisation of health and social-care. Its results will help to inform future mixed-methods research around pathways into care-homes and how best to support older people as care needs increase.

Lay abstract: Moving into a care-home is a life-changing experience for individuals and their families, but often provides a positive way to address care and social needs which cannot be met in the community. Making this move directly from a hospital admission has the potential to be more challenging and pressurised than moving from home. Despite this being such an important transition of care and outcome from healthcare services, little research has explored the topic. We do not know if those moving from hospital have the same care needs as those moving from home, the financial implications, or the outcomes experienced after moving into care. We know that there is significant variation in the chance of moving into a care-home from hospital, but reasons for this have not been established. This project will use anonymised data collected by Scottish care-homes and submitted to their regulator, in an annual census of activity over the previous year. These social care-generated data have been matched to the hospital, prescribing and long-term conditions data, collected routinely by the NHS. This will allow us to describe those who move into a care-home from hospital and compare them with those moving from home. We will be able to look at the outcomes of those two groups, compare costs and describe the variation in patterns of admission across Scotland. This application offers value for money as the data access, management and support costs are already covered. In addition, the research permissions to work with the data are all in place and the data are available, so work can begin immediately. A challenge when making use of existing data is that they have been collected for different, non-research, purposes and thus time is required to explore their meaning, tidy the datasets for analysis and describe their completeness. We have support to do this research, however, from those who collect and hold the data, including care-home providers, regulators and the Scottish Government. Our project Steering Group will have representation from these groups and from carers who have lived experience to help ensure we interpret the data correctly and share our findings in an accessible and meaningful way. Our closing Public Engagement Event will help ensure the findings are shared effectively. This research will help to understand better the populations moving into care-homes and direct future research about the role of care-homes in supporting the most complex older adults in society.

Research activity codes: 8.1 ORGANISATION AND DELIVERY OF SERVICES;8.2 HEALTH AND WELFARE ECONOMICS
Health categories: GENERIC HEALTH RELEVANCE