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Planning care for high-risk patients ‘reduces hospital days by half’

Researchers say they have dramatically reduced hospital admissions and bed days by using a simple case-finder tool to identify and plan care for high-risk patients.

In a study that will have implications for the national QIPP agenda to reduce expensive hospital activity, the researchers say they could reduce hospital bed numbers by 30 for each community health partnership (population around 90,000).

The study used the ‘Nairn Case-Finder' to identify 87 high-risk patients out of 10,860 patients from a general practice in Nairn, Scotland. These were then compared with 81 controls from other practices within NHS Highland.

Patients in the intervention group were offered an ‘anticipatory care plan' over 12 months, where a case manager found out what intermediate care was planned for the patient and their preferred place of care. They also initiated home improvements and helped the patient to access voluntary agencies.

Of those that survived from the anticipatory care plan group, there were 37 fewer admissions compared with the 12 months before the intervention – a statistically significant reduction of 43%.  There was a comparable reduction of 23.7% in the control group, but this was not statistically significant.

Similarly, the intervention group spent 510 fewer days in hospital – a significant reduction of 52%. This compared with a non-significant reduction of 13% in the control group.

Anticipatory care plans did not affect the number of deaths in the high-risk group, but fewer patients with anticipatory care plans died in hospital than in the control group. Three patients in the anticipatory care group died in hospital (18.8%) compared with 11 (73.3%) in the control group.

Study lead Dr Adrian Baker, a GP in Nairn, Scotland, said this demonstrated how anticipatory care planning could help patients and reduce costs.

He said: ‘The effect of this integrated approach on unplanned hospitalisation, in a period that is frequently characterised by chaotic and fragmented care, is a new finding and the potential savings identified here could have important implications for resourcing alternative care pathways.'

Professor Roger Jones, emeritus Professor of General Practice at King's College London, said the study was a good start in identifying the ways patients can be kept out of hospital.

 He said: ‘As the population ages and multimorbidity becomes an increasing problem, planned management, including the management of terminal illness, is increasingly required.'

‘This study helps to emphasise the importance and benefits of this approach, and identifies some of the key ingredients of integrated, anticipatory planning in primary care.'

Professor Louise Robinson, Professor of Primary Care and Ageing at Newcastle University and a GP in the city said: ‘Anticipatory care planning can affect hospitalisation at the end-of-life, but it is still a process that health and social care professionals find difficult to implement in practice'.

What is anticipatory care planning?

  • Discussing capacity issues
  • Initiating home improvements
  • Accessing voluntary agencies
  • Assessing patient understanding of their diagnosis and their condition
  • Recording the patient's preferred place of care and patient wishes for resuscitation
  • Mobilising support from the primary care team

Source: BJGP 2012, February 2012.