17 November 2006
Department of Health plans to limit the demand for hospital care by elderly people by providing better preventative community care will not work, the results of a pilot study suggest.
The findings mean primary care trusts still cannot know where best to focus their commissioning if they are to curb their expenditure, researchers writing in the British Medical Journal said.
UnitedHealth Europe was contracted to run pilots of their 'Evercare' model of patient 'case management' across nine primary care trusts from 2003. The model involves identifying elderly patients at high risk of emergency hospital admission and targeting them with community-based preventative and care services.
But whilst researchers led by the University of Manchester found improvements in care access and quality, they found 'that case management had no significant impact on rates of emergency admission, bed days or mortality in high risk cohorts.'
The researchers proposed that the failure to limit overall hospital episodes may be because improved access to health services meant previously untreated patients came into the system – an explanation supported by the DoH.
Since the pilots, the DoH has rolled the model out as central to the work of the 3000 new community matrons it plans to have in post by 2008.
Consultant geriatrician David Black questioned the DoH's commitment of over £4m to the scheme without prior assessment of its impact. He added: 'Frustratingly, this adds little to help primary care trusts decide where to focus their commissioning efforts.'
'The interim evidence of improved quality of care is welcomed… [but] the study does not support using nurse practitioners to reduce hospital admissions in patients who have had previous emergency admissions.'
A spokeswoman for the DoH said much had moved on since the pilots, which were completed between 2004 and 2005 and that the department was now working to identifying at risk patients even earlier.
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