Leads:
Dr Sarah Damery, Dr Janet Jones, Prof Kate Jolly (Long-term Conditions), Dr Agnieszka Latuszynska (Organisational Sciences)
Dates:
June 2021 – August 2022
Background:
Integrated Care Systems (ICS) in England must provide enhanced support to all care homes. Between August 2021 and August 2022, Birmingham Community Healthcare NHS Foundation Trust led the pilot implementation of a ‘wraparound’ support model for 26 care homes across Birmingham. Support included training for care home staff to help them identify and manage resident deterioration, and collaboration with other specialist services across primary, secondary and community care settings (e.g. wound care, mental health). The support model aimed to bring about early hospital discharge of care home residents and reduce A&E visits and hospital admissions from participating care homes. The NIHR ARC West Midlands carried out an evaluation of the support model to establish whether or not it was effective in meeting its aims.
The project protocol was reviewed by the Theme 1 PPIE group, and the project was presented to the group at a later meeting, allowing input into the study design and in particular the topic guide for the interviews.
Policy and Practice Partners:
Birmingham and Solihull CCG, Birmingham Community Healthcare NHS Foundation Trust.
Co-Funding partners:
Birmingham and Solihull CCG, Birmingham Community Healthcare NHS Foundation Trust.
Aims and Objectives:
To assess the effectiveness of the support model offered to care homes across Birmingham by describing what was done; understanding the experiences of care homes receiving support and the providers delivering support, and analysing trends over time in key outcome measures.
Methods:
Mixed methods evaluation that included semi-structured interviews (analysed thematically) with service commissioners and planners (n=5); service providers directly involved in delivering support to the care homes (n=12), and care home managers/senior staff within the participating care homes (n=6). Quantitative analysis of routinely-collected data was also carried out, comparing rates of hospital admissions, A&E visits and ambulance callouts within participating care homes for the 12 months of enhanced support (2021-22), against a pre-implementation baseline (2019-20). Outcomes were also assessed for participating care homes against a matched comparison cohort of care homes across Birmingham that did not receive extra support.
Main Results:
Rates of emergency care, ambulance use and hospital use within the 26 participating care homes reduced significantly from levels seen in the 12 month baseline period. There was an absolute reduction of 21.3% in the number of A&E visits from participating care homes, 13.5% reduction in emergency ambulance calls, and 21.6% reduction in acute hospital admissions. In the comparator cohort, emergency hospital attendances and admissions also fell significantly from baseline. However, whilst the overall trends in key outcomes were similar between participating care homes and those in the comparator cohort, A&E use and hospital admissions were significantly higher before implementation in the care homes who received enhanced support and had fallen to regional average rates after implementation. Interview participants highlighted increased care home staff capability and confidence in identifying resident deterioration proactively, and positive relationships developed between care homes and service providers. However, engagement with other services (e.g. mental health and primary care) was relatively poor.
Conclusions:
The enhanced, support provided in Birmingham was associated with multiple benefits. However, similar trends seen in comparator care homes raise questions about whether observed trends were due to the enhanced support or simply reflected trends already happening regionally.
Implications for Implementation:
Potential challenges to wider implementation included the impact of low levels of engagement from other providers across the health economy, such as primary care and mental health support. Establishing strong relationships between organisations working with the care home sector is fundamental for effective collaboration. The findings from this evaluation will inform the future commissioning of care home support services across Birmingham.
Protocol:
N/A
Publication:
Paper submitted for publication, outcome awaited.