Data & Charts
The role of matched controls in building an evidence base for hospital avoidance schemes: a retrospective evaluation6 Jan 2012Health Services Research
The Partnership for Older People Projects (POPP) were established by the Department of Health in 2005, with the aim of encouraging local councils to work in partnership with the NHS and voluntary, community and independent organisations to improve the health, wellbeing and independence of older people. The Nuffield Trust has evaluated the effectiveness of eight of the interventions piloted as part of POPP.
In recent years efforts have been made to deliver more care in community settings, with the aim of avoiding admissions to hospital, while also reducing net costs. The POPP initiative was funded by the Department of Health with the aim of testing different models of service – 29 local authority-led pilots received ring-fenced funding for two years, and offered 146 core interventions between them.
A national evaluation of the initiative was commissioned by the Department of Health and the findings were published in January 2010. This concluded that the initiative had improved users’ quality of life, with the size of the improvement varying according to the nature of the individual projects.
Our study found it is important to monitor hospital-avoidance interventions in real-time so that improvements can be made where necessary to improve effectiveness
We conducted a further evaluation examining eight of the 146 interventions in detail and using an innovative method to test whether they had an impact on hospital use. Our findings were published in the report: An evaluation of the impact of community-based interventions on hospital use in March 2011.
We used new data linkage techniques which allow the hospital use of individual participants to be tracked over several years, without compromising patient confidentiality.
We found that, when compared to matched control patients, there was no evidence of a reduction in emergency hospital admissions due to any of the eight POPP interventions we studied. In some instances, there were more admissions in the intervention group than in the control group. There were, however, encouraging signs that one of the interventions reduced admissions for a subgroup of participants at high predicted risk.
In the absence of a randomised controlled trial, we compared participants to matched control patients. Our methodology ensured that participants and controls were similar in terms of a very wide range of characteristics, however it is possible that our findings could be driven by other, unknown differences between the groups that we were unable to observe.
One possible explanation for our findings is that patients first entered into the interventions, the professionals may have identified problems that necessitated hospital admission.
Our findings suggest that the impact of hospital-avoidance interventions should be monitored as close to real time as possible because, if they are not effective, it might be possible to refine the intervention or connected services in order to improve their effectiveness.