The influence of home care supply on delayed discharges from hospital in England

BMC Health Services Research

Stephen Allan¹  Karen Jones¹  Daniel Roland¹  Gintare Malisauskaite¹  Kate Baxter²  Kate Gridley²  Yvonne Birks² 

[1] PSSRU, University of Kent, CT2 7NF, Canterbury, UK;Social Policy Research Unit, Department of Social Policy and Social Work, University of York, York, UK;

关键词: Delayed discharges;    Delayed transfers of care;    Home care;    Health care;    Social care;    Supply;   

DOI  :  10.1186/s12913-021-07206-5

来源: Springer

【 摘 要 】

BackgroundDelayed transfers of care (DTOC) of patients from hospital to alternative care settings are a longstanding problem in England and elsewhere, having negative implications for patient outcomes and costs to health and social care systems. In England, a large proportion of DTOC are attributed to a delay in receiving suitable home care. We estimated the relationship between home care supply and delayed discharges in England from 2011 to 2016.MethodsReduced form fixed effects OLS models of annual DTOC attributed to social care at local authority (LA)-level from 2011 to 2016 were estimated, using both number of days and patients as the dependent variable. A count of home care providers at LA-level was utilised as the measure of home care supply. Demand (e.g. population, health, income) and alternative supply (e.g. care home places, local unemployment) measures were included as controls. Instrumental Variable (IV) methods were used to control for any simultaneity in the relationship between DTOC and home care supply. Models for DTOC attributed to NHS and awaiting a home care package were used to assess the adequacy of the main model.ResultsWe found that home care supply significantly reduced DTOC. Each extra provider per 10 sq. km. in the average local authority decreased DTOC by 14.9% (equivalent to 449 days per year), with a per provider estimate of 1.6% (48 days per year). We estimated cost savings to the public sector over the period of analysis from reduced DTOC due to increased home care provision between £73 m and £274 m (95% CI: £0.24 m to £545.3 m), with a per provider estimate of savings per year of £12,600 (95% CI: £900 to £24,500).ConclusionDTOC are reduced in LAs with better supply of home care, and this reduces costs to the NHS. Further savings could be achieved through improved outcomes of people no longer delayed. Appropriate levels of social care supply are required to ensure efficiency in spending for the public sector overall.

【 授权许可】

CC BY