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The influence of home care supply on delayed discharges from hospital in England

BACKGROUND: Delayed transfers of care (DTOC) of patients from hospital to alternative care settings are a longstanding problem in England and elsewhere, having negative implications for patient outcomes and costs to health and social care systems. In England, a large proportion of DTOC are attribute...

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Autores principales: Allan, Stephen, Roland, Daniel, Malisauskaite, Gintare, Jones, Karen, Baxter, Kate, Gridley, Kate, Birks, Yvonne
Formato: Online Artículo Texto
Lenguaje:English
Publicado: BioMed Central 2021
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8641174/
https://www.ncbi.nlm.nih.gov/pubmed/34856973
http://dx.doi.org/10.1186/s12913-021-07206-5
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author Allan, Stephen
Roland, Daniel
Malisauskaite, Gintare
Jones, Karen
Baxter, Kate
Gridley, Kate
Birks, Yvonne
author_facet Allan, Stephen
Roland, Daniel
Malisauskaite, Gintare
Jones, Karen
Baxter, Kate
Gridley, Kate
Birks, Yvonne
author_sort Allan, Stephen
collection PubMed
description BACKGROUND: Delayed transfers of care (DTOC) of patients from hospital to alternative care settings are a longstanding problem in England and elsewhere, having negative implications for patient outcomes and costs to health and social care systems. In England, a large proportion of DTOC are attributed to a delay in receiving suitable home care. We estimated the relationship between home care supply and delayed discharges in England from 2011 to 2016. METHODS: Reduced form fixed effects OLS models of annual DTOC attributed to social care at local authority (LA)-level from 2011 to 2016 were estimated, using both number of days and patients as the dependent variable. A count of home care providers at LA-level was utilised as the measure of home care supply. Demand (e.g. population, health, income) and alternative supply (e.g. care home places, local unemployment) measures were included as controls. Instrumental Variable (IV) methods were used to control for any simultaneity in the relationship between DTOC and home care supply. Models for DTOC attributed to NHS and awaiting a home care package were used to assess the adequacy of the main model. RESULTS: We found that home care supply significantly reduced DTOC. Each extra provider per 10 sq. km. in the average local authority decreased DTOC by 14.9% (equivalent to 449 days per year), with a per provider estimate of 1.6% (48 days per year). We estimated cost savings to the public sector over the period of analysis from reduced DTOC due to increased home care provision between £73 m and £274 m (95% CI: £0.24 m to £545.3 m), with a per provider estimate of savings per year of £12,600 (95% CI: £900 to £24,500). CONCLUSION: DTOC are reduced in LAs with better supply of home care, and this reduces costs to the NHS. Further savings could be achieved through improved outcomes of people no longer delayed. Appropriate levels of social care supply are required to ensure efficiency in spending for the public sector overall.
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spelling pubmed-86411742021-12-06 The influence of home care supply on delayed discharges from hospital in England Allan, Stephen Roland, Daniel Malisauskaite, Gintare Jones, Karen Baxter, Kate Gridley, Kate Birks, Yvonne BMC Health Serv Res Research BACKGROUND: Delayed transfers of care (DTOC) of patients from hospital to alternative care settings are a longstanding problem in England and elsewhere, having negative implications for patient outcomes and costs to health and social care systems. In England, a large proportion of DTOC are attributed to a delay in receiving suitable home care. We estimated the relationship between home care supply and delayed discharges in England from 2011 to 2016. METHODS: Reduced form fixed effects OLS models of annual DTOC attributed to social care at local authority (LA)-level from 2011 to 2016 were estimated, using both number of days and patients as the dependent variable. A count of home care providers at LA-level was utilised as the measure of home care supply. Demand (e.g. population, health, income) and alternative supply (e.g. care home places, local unemployment) measures were included as controls. Instrumental Variable (IV) methods were used to control for any simultaneity in the relationship between DTOC and home care supply. Models for DTOC attributed to NHS and awaiting a home care package were used to assess the adequacy of the main model. RESULTS: We found that home care supply significantly reduced DTOC. Each extra provider per 10 sq. km. in the average local authority decreased DTOC by 14.9% (equivalent to 449 days per year), with a per provider estimate of 1.6% (48 days per year). We estimated cost savings to the public sector over the period of analysis from reduced DTOC due to increased home care provision between £73 m and £274 m (95% CI: £0.24 m to £545.3 m), with a per provider estimate of savings per year of £12,600 (95% CI: £900 to £24,500). CONCLUSION: DTOC are reduced in LAs with better supply of home care, and this reduces costs to the NHS. Further savings could be achieved through improved outcomes of people no longer delayed. Appropriate levels of social care supply are required to ensure efficiency in spending for the public sector overall. BioMed Central 2021-12-02 /pmc/articles/PMC8641174/ /pubmed/34856973 http://dx.doi.org/10.1186/s12913-021-07206-5 Text en © The Author(s) 2021 https://creativecommons.org/licenses/by/4.0/Open AccessThis article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/ (https://creativecommons.org/licenses/by/4.0/) . The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/ (https://creativecommons.org/publicdomain/zero/1.0/) ) applies to the data made available in this article, unless otherwise stated in a credit line to the data.
spellingShingle Research
Allan, Stephen
Roland, Daniel
Malisauskaite, Gintare
Jones, Karen
Baxter, Kate
Gridley, Kate
Birks, Yvonne
The influence of home care supply on delayed discharges from hospital in England
title The influence of home care supply on delayed discharges from hospital in England
title_full The influence of home care supply on delayed discharges from hospital in England
title_fullStr The influence of home care supply on delayed discharges from hospital in England
title_full_unstemmed The influence of home care supply on delayed discharges from hospital in England
title_short The influence of home care supply on delayed discharges from hospital in England
title_sort influence of home care supply on delayed discharges from hospital in england
topic Research
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8641174/
https://www.ncbi.nlm.nih.gov/pubmed/34856973
http://dx.doi.org/10.1186/s12913-021-07206-5
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