Recent Papers and Publications



The Community Hospital Model in Northern Sweden by Dr Mante Hedman Department of Public Health and Clinical Medicine, Umea University, Sweden

Dr David Seamrk, Vice President of the CHA, offers an analysis and review of the work of Dr Hedman following an interview with him.

Dr Hedman works as GP in the remote community of Storuman in northern Sweden and as an academic at the University of Umea, some 150 miles away. He has recently published and defended his thesis entitled ‘The Community Hospital Model in Northern Sweden’ (link). His findings have many resonances with the community hospital situation in the UK.

In Norrbotten and Vasterbotten Regions, 14 community hospitals serve rural municipalities, spanning nearly a quarter of Sweden’s landmass. Medical cover for these hospitals is provided by local GPs, providing continuity of care. The community hospital patient group is predominantly elderly (median age 80 years) with both direct admissions from the community for emergency care and end of life care and admissions from acute hospitals for rehabilitation following surgery for major fractures, for example. Common diagnoses in the elderly, such as heart failure and pneumonia were more likely to be admitted to community hospitals than to general hospitals. Care for patients with heart failure at community hospitals showed more detailed nursing notes, greater doctor continuity and less biomedical examinations compared with similar admissions in general hospitals. In interviews with Dr Hedman, rural GPs explained they would admit from the community if they felt that they could offer patient-safe care and they noted that proximity, patient knowledge from outpatient care and a holistic perspective on the patient can be seen as advantages for community hospitals compared to general hospitals in the care of elderly patients with multiple illnesses.

Dr Hedman travelled to New Zealand to visit rural hospitals and interview ‘district doctors’ (GPs) involved in providing medical care for patients in these hospitals. There were marked similarities between the Swedish and New Zealand models of community hospital care and indeed similar frustrations with medical and nursing staff vacancies and dependency on temporary staff. Overall, both groups of doctors found community hospital work satisfying but acknowledged stresses related to clinical uncertainty and having to make decisions regarding transfer of acutely unwell patients over long distances.

Dr Hedman’s work adds to the international community hospital literature and provides a real insight into the role community hospitals provide in the remote communities of Sweden. His work will help inform health planners in Sweden when considering the health care of isolated populations and also an example of models that might be applied to larger urban settings.  Link to Thesis here


Enhancing the care of older people: role of community-hospitals

Evelyn Prodger and Sue Greenwood, two CHA committee members, have published an article in the Journal of Community Nursing on Community Hospitals. 

"Community hospitals bridge the gap between primary and secondary care. They are geographically diverse local assets that offer a range of services, although inpatient services often focus on rehabilitation, most commonly for stroke and older people. Community hospitals are person-centred in their approach, nurse-led and work in a multidisciplinary way to support people to achieve their goals, maintain independence,  and improve health and wellbeing assets."   Prodger, E., Greenwood S. Enhancing the care of older people: role of community-hospitals  JCN 2024, Vol 38, No 1

Log on to the Journal of Community Nursing to read more here    


Integrated care in rural, remote or island communities

Dr Anne Hendry has put together a Special Issue of 9 papers from 7 countries for the Journal of Integrated Care on the topic of integrated care in rural, remote or island communities.   Dr Hendry reports in her editorial on one paper which she says "highlights the importance of collaboration between healthcare planners and urban/community planning authorities when locating new community healthcare facilities............. The paper from Italy reminds us of the importance of place based planning and collaboration and the essential contribution of community hospitals in creating sustainable healthy communities in remote, rural coastal and island settings." 

Dr Helen Tucker of the CHA is one of the co-editors.  Read the editorial here 

Hendry, A.Kurpas, D.Munoz, S.-A. and Tucker, H. (2024), "Guest editorial: Integrated care in rural, remote or island communities", Journal of Integrated Care, Vol. 32 No. 1, pp. 1-5.


“The response of United Kingdom Community Hospitals to the COVID-19 Pandemic: an Appreciative Inquiry.”

Tucker H, Seamark D, Prodger E. The response of United Kingdom Community Hospitals to the Covid-19 Pandemic: an appreciative Inquiry. International Journal of Integrated Care. 2022;22(S3):221. DOI:

"Community hospitals have been described as integrators, and the experience of staff during the pandemic has shown that collaborative working has strengthened over time.  Staff have reported that there is a greater appreciation of the role of community hospitals locally within communities and within the wider health and social care system."

Download the paper here


"Response of UK community hospitals to the COVID-19 pandemic: an appreciative inquiry" 
Seamark DAProdger EJay T, et al 


‘Localism and intimacy, and... other rather imponderable reasons of that sort’: A qualitative study of patient experience of community hospitals in England

Deborah Davidson and team have published a paper on community hospitals in England.  This was a qualitative study  involving patients carers and staff in 9 case study hospitals. The CHA was pleased to be involved in the study, on the research team and joint Board.

The authors conclude that: "The study suggests the need to weigh the full range of these dimensions of patient experience—functional, interpersonal, social and psychological—when assessing the role and contribution of community hospitals."

Read the article here  Read the full study on the Value of Community Hospitals here 


Outcomes of Community Hospital Care

Pianori D, Adja KYC, Lenzi J, Pieri G, Rossi A, Reno C, et al. The Contribution of Case Mix, Skill Mix and Care Processes to the Outcomes of Community Hospitals: A Population-Based Observational Study. International Journal of Integrated Care. 2021;21(2):25. DOI:

Heterogeneity in case mix reflects the nature of CHs, which play context-specific roles as integrators between primary care services and hospitals. 


Effectiveness of Care in a Community Hospital

Ribbink ME, Macneil-Vroomen JL, van Seben R on behalf of the AGCH study group, et al   Investigating the effectiveness of care delivery at an acute geriatric community hospital for older adults in the Netherlands: a protocol for a prospective controlled observational study    BMJ Open 2020;10:e033802. doi: 10.1136/bmjopen-2019-033802

Patient Experience and Satisfaction in a Community Hospital

Marthe E. Ribbink, Catharina C. Roozendaal, Janet L. MacNeil-Vroomen, Remco Franssen, Bianca M. Buurman  (2021) Patient experience and satisfaction with admission to an acute geriatric community hospital in the Netherlands: a mixed method study   Journal of Integrated Care  ISSN: 1476-9018

In general, study participants experience the admission to the AGCH as positive and are satisfied with the care they received; there were also suggestions for improvement.


Intermediate Care Models

Duygu Sezgin et. al. (April 2020) "Defining the characteristics of intermediate care models including transitional care: an international Delphi study"       Aging Clinical and Experimental Research

The study was on behalf of European Union Advantage Joint Action Work Package 7 partners in collaboration with the International Foundation for Integrated Care Special Interest Group on Intermediate Care.  Participating authors in the study included Helen Tucker, John Young, Claire Holditch and Anne Hendry.    The Delphi study identified key defining features of intermediate care and led to an agreement on a definition of intermediate care.  "Intermediate care represents time-limited services which ensure continuity and quality of care, promote recovery, restore independence and confidence at the interface between home and acute services, with transitional care representing a subset of intermediate care."   The study also concluded that models of intermediate and transitional care "are best delivered by an interdisciplinary team within an integrated health and social care system where a single contact point optimises service access, communication and coordination." 


Delayed discharges within community hospitals

Lynne Mann, (2016)"Delayed discharges within community hospitals: A qualitative study investigating the perspectives of frontline health and social care professionals", Journal of Integrated Care, Vol. 24 Iss: 5/6, pp.260 - 270

Integrated Care

Tucker, H., (2013) Discovering integrated care in community hospitals
Journal of Integrated Care ISSN: 1476-9018

This study has shown that integrated working is present in community hospitals. This research provides new knowledge on the types of integrated care present in a range of community hospital services. The study shows a tradition of joint working, the presence of multiple simultaneous types of integration and demonstrated that integrated care can be provided in a range of services to patients of all ages in local communities.

Patient Transfers Between Acute and Community Hospitals

Endacott, R., McDonagh, P., Gidman, J., Bromige, R., Arti, M.  (2013)  Transfer and readmission of patients between acute and community hospitals: a retrospective review Quality in Primary Care (2015) 23 (1): 46-50

Timing of transfer from AH to CH should be optimised to ensure patients are discharged when the full range of services is available. CH services could be configured differently with diagnostic and access to doctors provided for longer hours in a smaller number of CH.

Re-Inventing Community Hospitals

Swanson, J and Hagan, T (2016) "Reinventing the community hospital: a retrospective population-based cohort study of a natural experiment using register data"  BMJ Open 2016;6:e012892 doi:10.1136/bmjopen-2016-012892 Health policy   

A recently published study from Norway has reviewed community hospitals and concluded that they make a valuable contribution to local health systems. Read more "Our findings suggest that this type of intermediate care is a viable option in an effort to alleviate the burden on hospitals by reducing the acute secondary care admission volume."

England must support its community hospitals

Seamark, D. (2016) England must support its community hospitals BMJ 2016; 354 doi:

The letter calls for a halt to the indiscriminate reductions of services and closures in community hospitals until the outcome of current research studies are available. The article also refers to countries such as Italy and Norway, where they have a clear strategy to develop community hospitals and intermediate care.  The letter was "letter of the week" in the BMJ, and it is hoped that it raises the profile of community hospitals and encourages a debate.


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