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US-style management can cut hospital stays

By Anna Hodgekiss

and Ian Cameron

US-inspired case management techniques used to treat high-risk patients can halve the number of days spent in hospital.

An analysis of trusts in Northumbria piloting techniques by US company Kaiser Permanente resulted in a 50 per cent reduction in bed days for COPD and asthma patients.

Bed days for some heart disease and stroke patients were cut by nearly two-thirds.

Professor Chris Ham, professor of health policy and management at the University of Birmingham's Health Services Management Centre and author of the study, said the results showed the NHS had a lot to learn from Kaiser's approach.

Kaiser's lower use of beds is driven by case management in chronic care of high-risk patients and active management of them during hospital stays. Health and social care teams are closely integrated in primary and secondary care.

The Northumbrian pilot created a network of three acute trusts closely integrated with primary care. A GP was appointed as medical director at the overseeing health care trust.

Kaiser clinical software used found 23 per cent of hospital patients were at the wrong level of care ­ with most requiring a 'lower intensity' of care.

Professor Ham, a former strategy director at the Department of Health, said preliminary findings showed Kaiser techniques also cut emergency admissions in Northumbria.

He said he expected the results in Northumbria to be improved in Birmingham and Torbay, where plans for a new hospital include 20 per cent fewer beds than current levels.

'The NHS is not integrated, regardless of what the Government says, largely because there are barriers between commissioners and providers,' he said. 'By joining up these services, patients could be treated better.'

Dr Grant Ingrams, secretary of West Midlands regional LMC, remained sceptical: 'Instead of these schemes, most GPs would jump at the chance of more control over their district nurses and get additional resources to manage patients ­ and they'd do it a hell of a lot better.'

Next phase of evolution

Kaiser Permanente says it is embarking on the 'next phase of its evolution' with the NHS.

The company, renowned for blurring the boundary between primary and secondary care, is expanding the work it has undertaken with the Health Services Management Centre at the University of Birmingham.

As part of the creation of a collaborative centre to step-up its NHS advisory involvement it is planning to increase the number of 'masterclasses' it holds for NHS clinicians and managers.

It might also relaunch learning visits for NHS workers to Kaiser's US facilities.

Robert Crane, senior vice-president of research and policy development and a director of Kaiser's institute for health policy, told Pulse it had ruled out directly providing services to the UK, but remained interested in the NHS.

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