Characteristics and mortality rates among patients requiring intermediate care: a national cohort study using linked databases.
Evans CJ, Potts L, Dalrymple U, Pring A, Verne J, Higginson IJ, Wei G on behalf of SPACE. BMC Medicine 2021; 19(1): 48.
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This is a novel national cohort study of adults admitted to intermediate care units in England using linked individual Hospital Episode Statistics and death registration data. This is a patient group in transition between hospital and home who require intermediate care. We examined the patient characteristics and the factors associated with mortality over 1 year post-admission to an intermediate care unit to inform priorities for care. 76,704 adults were admitted to 220 intermediate care units in 2016. This is an older cohort with median age 81 years living with multiple conditions. Over one in four died within a year of their index admission. The traditional emphasis on rehabilitation and recovery in intermediate care units has changed with an ageing population and the need for greater integration of palliative care. Indicators for palliative care assessment are respiratory conditions, dementia, liver disease, cancer and rising multi-morbidity and unplanned hospital admission.
Catherine Evans, lead author of the report has said:
"This is the first national cohort study on community hospitals in England. We identified over 76,000 people admitted to 220 community hospitals. This is an older population living with multiple chronic progressive conditions. Over one in four died within a year of their admission. To deliver high-quality care, requires integrated care between community hospitals, geriatric care and palliative care, and a skilled workforce to manage multiple care needs across the care continuum and into end of life."
"To deliver high quality care requires a model of integrated care between community hospitals, geriatric care and palliative care, and a skilled workforce to manage multiple care needs across the continuum of care and into end of life."
This article is published in e-hospice on 18th March 2021. The article also gives links to us at CHA and to resources concerning palliative and end of life care.
Read more on the ehospice website here
Preferences and priorities to manage clinical uncertainty for older people with frailty and multimorbidity in community hospitals
Tunnard I, Ellis-Smith C, Dawkins M, Higginson IJ and Evans CJ on behalf of SPACE.
This summary sets out the stakeholder consultation with staff and individual interviews with patients about priorities for care, and the use of structured documents to enhance key care processes of comprehensive assessment, communication with family and continuity of care on discharge.
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