Rights statement: http://journals.cambridge.org/action/displayJournal?jid=PHC The final, definitive version of this article has been published in the Journal, Primary Health Care Research and Development, 12 (3), pp 223-236 2011, © 2011 Cambridge University Press.
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Research output: Contribution to Journal/Magazine › Journal article › peer-review
Research output: Contribution to Journal/Magazine › Journal article › peer-review
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TY - JOUR
T1 - Case management for people with long-term conditions
T2 - impact upon emergency admissions and associated length of stay
AU - Reilly, Siobhan
AU - Abell, Jessica
AU - Brand, Christian
AU - Hughes, Jane
AU - Berzins, Kathryn
AU - Challis, David
N1 - http://journals.cambridge.org/action/displayJournal?jid=PHC The final, definitive version of this article has been published in the Journal, Primary Health Care Research and Development, 12 (3), pp 223-236 2011, © 2011 Cambridge University Press.
PY - 2011/7
Y1 - 2011/7
N2 - Aim This paper describes findings from a study that evaluated the implementation and impact of case management for long-term conditions (CMLTC) in 10 primary care trusts (PCTs).Background Patients who have long-term conditions and complex health and social needs may require case management to deliver and coordinate their care from a range of agencies.Methods A cross-sectional postal survey of managers with lead responsibility for CMLTC in each PCT is adopted to describe the implementation of services. A retrospective cohort analysis of longitudinal routinely collected admission data for patients enrolled within the CMLTC service (nine months before and nine months after the entry; n = 867) is used to measure their impact.Findings The organisation of case management varied between PCTs in some aspects despite a high level of coordination across the geographical area. Mean emergency admissions and associated length of stay (LOS) for patients reduced significantly in the nine months after the service entry. There were a number of fairly robust positive and negative influences on these outcome measures in the regression analysis. Most patients with a history of emergency admissions experienced a marked improvement over time. However, most of those without any or with few admissions experienced an increase in admissions and corresponding LOS. Furthermore, a proportion of frequent service users with particular diagnoses also experienced an increase or remained at a high level. A very modest effect was shown with regard to the features of case management arrangements. For each day spent in hospital before service entry, patients are predicted to experience a reduction of nearly one day after. The main contributor explaining increases in LOS for emergency admissions was the number of primary and secondary diagnoses. Each added diagnosis is associated with a 2.4-day increase in LOS, everything else being equal.
AB - Aim This paper describes findings from a study that evaluated the implementation and impact of case management for long-term conditions (CMLTC) in 10 primary care trusts (PCTs).Background Patients who have long-term conditions and complex health and social needs may require case management to deliver and coordinate their care from a range of agencies.Methods A cross-sectional postal survey of managers with lead responsibility for CMLTC in each PCT is adopted to describe the implementation of services. A retrospective cohort analysis of longitudinal routinely collected admission data for patients enrolled within the CMLTC service (nine months before and nine months after the entry; n = 867) is used to measure their impact.Findings The organisation of case management varied between PCTs in some aspects despite a high level of coordination across the geographical area. Mean emergency admissions and associated length of stay (LOS) for patients reduced significantly in the nine months after the service entry. There were a number of fairly robust positive and negative influences on these outcome measures in the regression analysis. Most patients with a history of emergency admissions experienced a marked improvement over time. However, most of those without any or with few admissions experienced an increase in admissions and corresponding LOS. Furthermore, a proportion of frequent service users with particular diagnoses also experienced an increase or remained at a high level. A very modest effect was shown with regard to the features of case management arrangements. For each day spent in hospital before service entry, patients are predicted to experience a reduction of nearly one day after. The main contributor explaining increases in LOS for emergency admissions was the number of primary and secondary diagnoses. Each added diagnosis is associated with a 2.4-day increase in LOS, everything else being equal.
KW - Adolescent
KW - Adult
KW - Aged
KW - Analysis of Variance
KW - Case Management
KW - Cross-Sectional Studies
KW - Emergency Service, Hospital
KW - Female
KW - Great Britain
KW - Health Care Surveys
KW - Humans
KW - Length of Stay
KW - Long-Term Care
KW - Male
KW - Middle Aged
KW - Primary Health Care
KW - Regression Analysis
KW - Retrospective Studies
KW - Time Factors
KW - Young Adult
UR - http://www.scopus.com/inward/record.url?scp=84555202606&partnerID=8YFLogxK
U2 - 10.1017/S1463423611000028
DO - 10.1017/S1463423611000028
M3 - Journal article
C2 - 21798120
AN - SCOPUS:84555202606
VL - 12
SP - 223
EP - 236
JO - Primary Health Care Research and Development
JF - Primary Health Care Research and Development
SN - 1463-4236
IS - 3
ER -