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Age and Ageing 2005 34(6):577-583; doi:10.1093/ageing/afi179
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© The Author 2005. Published by Oxford University Press on behalf of the British Geriatrics Society. All rights reserved. For Permissions, please email: journals.permissions@oxfordjournals.org

A whole system study of intermediate care services for older people

John B. Young1, Mike Robinson1, Sue Chell1, Diana Sanderson2, Stephen Chaplin2, Eileen Burns3 and Jon Fear4

1 Nuffield Institute for Health, Leeds, UK
2 York Health Economics Consortium, York, UK
3 Leeds General Infirmary, Leeds, UK
4 Leeds West, Primary Care Trust, Leeds, UK

Address correspondence to: J. B. Young. Email: john.young{at}bradfordhospitals.nhs.uk

Background: intermediate care (IC) services have been widely introduced in England and have the strategic objectives of reducing hospital and long-term care use. There is uncertainty about the clinical outcomes of these services and whether their strategic aims will be realised.

Setting: a metropolitan city in northern England.

Design: a quasi-experimental study comparing a group of older people before and after the introduction of an IC service. A quota sampling method was used to match the groups.

Subjects: patients presenting as emergency admissions to two elderly care departments with falls, confusion, incontinence or immobility.

Intervention: a city-wide service in which a joint care management team (multi-agency, multi-disciplinary) assessed patient need and purchased support and rehabilitation from sector-based IC teams.

Outcomes: Nottingham Extended Activities of Daily Living score, Barthel Index, Hospital Anxiety and Depression score, mortality, readmission to hospital, and new institutional care placement at 3, 6 and 12 months post-recruitment.

Results: there were 800 and 848 patients, respectively, in the control and intervention groups. Clinical outcomes, hospital and long-term care use were similar between the groups. Uptake of IC was lower than anticipated at 29%. An embedded case–control study comparing the 246 patients who received IC with a matched sample from the control group demonstrated similar clinical outcomes but increased hospital bed days used over 12 months (mean +8 days; 95% CI 3.1–13.0).

Conclusion: this city-wide IC service was associated with similar clinical outcomes but did not achieve its strategic objectives of reducing long-term care and hospital use.

Keywords: intermediate care, older people, clinical trial, elderly

Received October 19, 2004; accepted in revised form July 14, 2005.


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