An evaluation of the impact of community-based interventions on hospital use

Adam Steventon

Dr Martin Bardsley

Professor John Billings

and others

Research summary & report

10 Mar 2011

Project:

Partnership for Older People: evaluation of impact on emergency hospital use

Developing evaluation methods to help the NHS provide care more effectively

Nuffield Trust Data Lab: exploiting existing information in new ways

Area of work:

Evaluation, Integrated care, Research methods & information tools

In recent years, the Department of Health has encouraged efforts to deliver more care in community settings, with the joint aims of avoiding unplanned admissions to hospital and reducing net costs. An evaluation of the impact of community-based interventions on hospital use: a case study of eight Partnership for Older People Projects (POPP) presents the findings of a project to evaluate the impact that a small set of community based interventions had on the rates of emergency hospital admissions in their respective areas.

Summary

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 was commissioned by the Department of Health to evaluate a small but carefully selected set of eight POPP interventions and examine whether these interventions were successful at preventing unplanned hospital admissions.

This study found it is important to monitor hospital-avoidance interventions in realtime so that improvements can be made where necessary to improve effectiveness

We used a new and sophisticated person-based approach that involved comparing the outcomes for participants in the interventions with matched controls. New data linkage techniques developed with the NHS Information Centre allowed us to obtain person-level data about hospital activity without compromising confidentiality. This meant we could examine the patterns of hospital use of the individuals who received the POPP interventions, rather than relying on aggregated data for their entire primary care trust area.

The control groups were very well matched in terms of a wide range of characteristics including age, sex, area-level deprivation, medical diagnosis, predicted risk of hospital admission and prior health care use. This research method allowed us to measure more precisely the impact of the interventions on hospital use.

An evaluation of the impact of community-based interventions on hospital use, by Adam Steventon, Dr Martin Bardsley, Professor John Billings, Theo Georghiou, and Dr Geraint Lewis, presents details of the methods used, the findings of the evaluation and explores the advantages of this novel evaluation approach. It will be of interest to health and social care policy-makers, senior managers and practitioners, and others involved in commissioning, as well as academics and students in the fields of health care and social policy.