New research helps address problem of hospital bed blocking

July 17, 2018 by Toby Leigh, University of Plymouth

A new study has questioned assumptions about the best way to stop unnecessary admissions and extended hospital stays for frail, elderly people.

Published in Health Services and Delivery Research, the study was led by the University of Plymouth's Professor in Health Services Research Rod Sheaff.

The research, carried out for the National Institute for Health Research Health Services and Delivery Research programme (NIHR HS&DR) and supported by the NIHR Collaboration for Leadership in Applied Health Research and Care South West Peninsula (NIHR PenCLAHRC), found that new multispecialty community providers (MCPs) could be effective in preventing such admissions under certain conditions. But evidence as to whether they reduced costs overall for the health was 'mixed'.

The key finding of the study, "From programme theory to logic models for multispecialty community providers: a realist evidence synthesis," was that multidisciplinary care teams are absolutely crucial to the effectiveness of MCPs, and must contain the right professions and organisations, involve patients, and communicate with each other well.

MCPs aim to bring together primary care and community-based health and care services, to offer care close to people's homes, and in as many cases as possible, keep them out of hospital and save money.

By improving systems outside hospitals, MCPs also aim to address the problem of so-called 'bed blocking', where patients cannot be discharged because there is insufficient care to look after them.

They were one of the new care models set out by NHS England in its Five Year Forward View, published in October 2014. Since then, the model has been trialled in 14 'vanguards' up and down the country.

Professor Sheaff, who is part of the University's Faculty of Business and Interim Director of the Institute for Social, Policy and Enterprise Research, and his colleagues looked at the way MCPs were used in other countries, in order to examine some of the assumptions being made about them in the UK. The work involved establishing what assumptions policymakers had about MCPs and how they would help reduce admissions and costs, then evaluating these assumptions against international research evidence.

Armed with its findings, the team showed how the plans for MCPs might be changed to make them more likely to work, and fed this back to the NHS and patient organisations.

Professor Sheaff said:

"Broadly, we found three things. The key thing is that members of the multidisciplinary care team are communicating effectively. This is by far the most important factor.

"We also found for teams like this to work, everyone needs to be able to access patient information – the ideal would be a single patient record, that is accessible to social services as well. The tech side is not the problem – the problem is designing the system so practitioners can use it. Different approaches to privacy across different parts of and social care are an element of this.

"The third thing is that if you get the systems right, they do reduce unnecessary admissions of old people – if they are properly done. But it is less clear if, or why, they save money in the process."

The team looked at studies carried out in the last two years, in countries that are part of the Organisation for Economic Cooperation and Development (OECD). More than 1,300 publications were reviewed, with 116 selected for closer examination.

Explore further: ​Review highlights evidence for investment in physiotherapy for musculoskeletal conditions

More information: Rod Sheaff et al. From programme theory to logic models for multispecialty community providers: a realist evidence synthesis, Health Services and Delivery Research (2018). DOI: 10.3310/hsdr06240

Related Stories

​Review highlights evidence for investment in physiotherapy for musculoskeletal conditions

July 9, 2018
A new report from the National Institute for Health Research (NIHR) shows investment in physiotherapy services for musculoskeletal conditions improves patient outcomes and reduces overall healthcare costs.

The need to understand what works in social prescribing

July 18, 2017
Social prescribing has the potential to address many of the factors that perpetuate illness, decrease quality of life and add to health care costs - such as social isolation, inactivity and smoking. It has expanded the options ...

Intensive management for sicker patients increases outpatient care but not costs

June 4, 2018
Intensive management of patients at high-risk for hospitalization increases use of outpatient care but does not increase overall costs. While the costs associated with caring for these patients were not reduced, researchers ...

New study shows evidence that health information exchanges improve care, reduce costs

May 30, 2018
An updated systematic review of recent studies of health information exchanges found evidence the exchanges reduced both the cost of health care and its use. That contrasts with an assessment published three years ago that ...

Integrated care interventions can reduce hospital activity for patients with chronic diseases

November 22, 2016
New research has shown that integrated care interventions can be effective in reducing hospital activity, but the evidence base is poor and suggests that transforming services to integrate health and social care may not be ...

Guidance for metrics to improve patient care

July 11, 2017
People with long term conditions, multiple long term conditions and those at the end of life could see their care better tailored to their needs, as the first openly-available comprehensive resource of measures relating to ...

Recommended for you

First ever meta-analysis on Indian lead exposure reveals link to devastating intellectual disability in children

October 12, 2018
New Macquarie University research has revealed the devastating disease burden associated with elevated blood lead levels in India. The results of the first ever meta-analysis of Indian blood lead levels found the burden of ...

The long-term effects of maternal high-fat diets

October 12, 2018
If a mother eats a high-fat diet, this can have a negative effect on the health of her offspring—right down to her great-grandchildren. This is the conclusion drawn by researchers at ETH Zurich from a study with mice.

Sit-stand office desks cut daily sitting time and appear to boost job performance

October 11, 2018
Sit-stand workstations that allow employees to stand, as well as sit, while working on a computer reduce daily sitting time and appear to have a positive impact on job performance and psychological health, finds a trial published ...

Molecular link between body weight, early puberty identified

October 11, 2018
Becoming overweight at a young age can trigger a molecular chain reaction that leads some girls to experience puberty early, according to new research published in Nature Communications.

Hearing and visual aids linked to slower age-related memory loss

October 11, 2018
Hearing aids and cataract surgery are strongly linked to a slower rate of age-related cognitive decline, according to new research by University of Manchester academics.

Hundreds of patients with undiagnosed diseases find answers, study reports

October 10, 2018
More than 100 patients afflicted by mysterious illnesses have been diagnosed through a network of detective-doctors who investigate unidentified diseases, reports a study conducted by scientists at the Stanford University ...


Please sign in to add a comment. Registration is free, and takes less than a minute. Read more

Click here to reset your password.
Sign in to get notified via email when new comments are made.