Study shows that eight community based interventions for older people did not reduce the need for hospital care

A study by the Nuffield Trust of eight community-based interventions (forming part of the Department of Health funded Partnership for Older People Projects (POPP) initiative) indicated that none had led to a reduction in emergency hospital admissions despite a reasonable expectation that at least four of them would.

There are many different ways in which care services try to reduce the needs for hospital admission.  With an ageing population, greater prevalence of long term conditions and a squeeze on NHS and social care budgets, the search for preventive care, of better quality and lower cost, is more urgent than ever.

The POPP initiative as a whole – comprising 29 projects which between them operated a total of 146 core interventions throughout the NHS in England – was designed to improve care for older people, and in particular increase the use  of preventive care to  reduce the reliance on undesirable hospital admissions (Note 2).

The Department of Health commissioned the Nuffield Trust to use a new evaluation method to look at whether a selected subset of eight POPP interventions led to reduction in use of hospitals.  By using data linkage techniques, Nuffield Trust researchers were able to compare the hospital usage patterns of individuals who received POPP interventions with a matched control group.  This individual person level approach is generally better than having to rely on aggregated data for an entire PCT area.

The eight interventions ranged from a programme of support workers who worked alongside community matrons with people with long-term conditions to an intermediate care scheme supporting people on discharge from hospital. The full results are available in: An evaluation of the impact of community based interventions on hospital use: a case study of eight Partnership for Older People Projects (POPP). In summary, the evaluation found:

• When compared to matched control patients none of the POPP interventions studied were associated with a reduction in emergency hospital admissions;
• In some instances, there were more admissions in the intervention group than in the control group;
• One intervention reduced the number of bed days following emergency admissions, reduced elective admissions and reduced outpatient attendances but, overall, did not reduce emergency hospital admissions.

The research team notes that other benefits might have arisen from these projects – they were not designed purely to reduce admissions.  For example, a separate national evaluation of the whole POPP projects pointed to improvements in quality of life and satisfaction with care services.

Commenting on the findings, Dr Martin Bardsley, Director of Research at the Nuffield Trust said: ‘The findings will come as a disappointment to those hoping that these schemes were able to reduce the need for hospital care. However, what has emerged strongly from this project is the potential of the evaluation approach we developed using matched control groups. This has a wide range of applications and could be used to undertake evaluations that can better inform decision making.’

The authors make a number of recommendations, including:

• The impact of hospital-avoidance interventions should be monitored in as close to real-time as possible. This will mean that there is the possibility to refine the intervention or connected services in order to improve its effectiveness;
• NHS commissioners should consider using these methods more widely to test whether existing preventive care interventions are achieving their aims. The impact on the NHS of local authority interventions can also be evaluated using NHS datasets in this way;
• The potential to improve the quality of care while reducing net ‘downstream’ costs is substantial. Further innovation is therefore essential, both in terms of refining the case finding process and in the design of interventions.