Area of work:

NHS North Somerset is in the process of establishing 'community wards' in order to improve the care and health of patients who are at risk of unplanned hospital admission. Nuffield Trust researchers are helping the NHS to evaluate this new intervention.

Community wards are a variant of virtual wards, which were first developed in Croydon in 2006. These use the systems, staffing and daily routine of a hospital ward to deliver multidisciplinary care to patients in their own homes with the aim of preventing unplanned hospital admissions.  In a related project, Nuffield Trust researchers are evaluating the virtual wards in Croydon, Devon and Wandsworth.

Control groups

One of the key aims of community wards is to prevent unplanned hospital admissions.  However, without careful design, evaluations of hospital-avoidance interventions can be distorted by the phenomenon of regression to the mean.  This is the tendency for patients who are currently experiencing a high rate of unplanned hospital admissions to experience fewer hospital admissions over time, even without a specific intervention taking place. 

The Nuffield Trust has extensive experience of evaluating high profile interventions that aim to reduce unplanned hospital admissions

The approach we will be adopting seeks to overcome this problem by constructing a control group of patients drawn from similar areas of the country. These control patients are chosen to match the characteristics of the intervention group as closely as possible across a wide range of variables that are recorded in routine data.

The Nuffield Trust has extensive experience in this type of research, for example with the evaluation of the Partnerships for Older People Projects (POPP) for the Department of Health; the evaluation of the virtual wards in Croydon, Devon and Wandsworth; and the evaluation of the national Integrated Care Pilots.  

What sets this current project apart from the other evaluations that we are conducting elsewhere is that we will supply NHS North Somerset with intermediate updates throughout the duration of the project.  These 'formative' results should help guide how the community wards project develops over time rather than waiting for a final 'summative' report at the end of the project. 

Outcome measures

During the course of the research we will be providing analyses of observed differences in:

  • Rates of inpatient admission and hospital bed use;
  • Rates of outpatient attendance;
  • Associated costs;
  • Rates of A&E attendance (subject to data quality).

Inevitably, the provisional nature of any analyses we produce before the end of the formal evaluation period means that our interim findings will need to be interpreted carefully. Nuffield Trust researchers will therefore meet regularly with staff from NHS North Somerset to help interpret the emerging findings. 

The advantage of this approach is that as we feed back our interim results, the initial findings may be used to guide the development of the community wards project in North Somerset in as close to real-time as is feasible.

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