Community matrons are nurses who work intensively with patients with complex health needs, with the aim to improve the quality of care, while preventing unnecessary hospital admissions. We are carrying out an evaluation to understand the impact they have had on hospital use. This is particularly important as, nationally, the number of emergency hospital admissions has been increasing, but such admissions are often both expensive to the NHS and undesirable for the patient concerned.
Community matrons are experienced, skilled nurses who use case management techniques to help patients with complex health needs. Their case management work has been central to the Government's policy for the care of people with long-term conditions since the publication of the NHS Improvement Plan in 2004.
Although it is often believed that case management can prevent hospital admissions, the evidence is not conclusive. An initial pilot of one model of case management conducted in 2003-05 in nine sites in the UK (called Evercare) concluded it had had no significant effect on rates of emergency admission, bed days, or mortality in high risk patients. A review of the international evidence published in 2004 found only weak evidence for the effectiveness of case management in preventing admissions to acute care in elderly patients.
We are assessing the impact of community matron services on rates of emergency admission, bed days and in-patient mortality
In this project, our researchers are using routine administrative data sets to look back over a period of several years and determine whether community matrons have had an impact on hospital admissions.
Evaluations in this area are often complicated by the natural tendency that patients who have recently had a high number of hospital admissions have to see reductions in use over time, even without a specific intervention (“regression to the mean”). Without careful analysis, this phenomenon can lead to an overestimate of the effectiveness of an intervention at reducing hospital admissions, since some of the natural reduction can mistakenly be attributed to the intervention. We are exploring ways to control for regression to the mean using innovative evaluation methodologies such as matched control groups.
One of the lessons learnt from the Evercare project was that case management could be targeted based on the outputs of a predictive model, such as PARR or the Combined Model. Whereas case management has traditionally been targeted on patients with a history of hospital use, predictive models allow services to identify patients who are at high risk of experiencing a hospital admission in future. We are particularly interested in working with community matron services who have been using predictive risk models to identify patients.
We would like to work with up to five community matron services to understand the impact they may have had on hospital use. If you would like to be involved, please contact Adam Steventon.
Results from our evaluation will be published in late 2012.