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Research Questions

  1. What is the impact the Older People's Programme had on hospital use?
  2. Are changes in hospital use due to specific parts of the programme, such as Holistic Assessments (HAs) and Integrated Care Management (ICM)?

The study aims to estimate the impact on secondary care utilisation and costs of the Older People's Programme; a multi-faceted primary care intervention, including Holistic Assessments and Integrated Care Management packages for older people identified as being at higher risk of avoidable hospitalisation. Based on an observational study among 94 GP practices in Southwark and Lambeth and 263 control practices from other parts of England, GP practice level data were analysed from 2009 to 2016 (intervention operated from 2012-2016). The results showed that there was evidence of reduced A&E attendance in the fourth year of the programme compared to that expected in the absence of the intervention, but no evidence of reduced emergency admissions. Overall, outpatient attendances and elective admissions were reduced by the end of the programme. The costs of the programme were £149 per resident aged 65 and over but the savings in hospital costs were only £86 per resident aged 65 and over, equivalent to a net increase in health service expenditure of £64 per resident. The number of Holistic Assessments carried out by GPs and consequent Integrated Care Management were both associated with significant increases in elective activity and costs. The Older People's Programme was not cost-saving. Some aspects of the Programme were associated with increased costs of elective care, possibly through the identification of unmet need. Interventions to improve integration of care are more likely to be judged successful if the aim is to improve quality of care rather than reduce cost.

Key Findings

  • There was evidence of reduced A&E attendance in the fourth year of the programme compared to that expected in the absence of the intervention but no evidence of reduced emergency admissions.
  • The costs of the programme were £149 per resident aged 65 and over but the savings in hospital costs were only £86 per resident aged 65 and over, equivalent to a net increase in health service expenditure of £64 per resident.
  • The number of Holistic Assessments carried out by GPs and consequent Integrated Care Management were both associated with significant increases in elective activity and costs.

Research conducted by

The research described in this report was prepared for Guy's and St Thomas' Charitable Trust and conducted by RAND Europe.

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