Table 1
Timeline of major changes to models of care in NEHF.
| 2015 April to 2018 March | Funding: The NEHF Vanguard received £14.3 million of national non-recurring funding spread across three years (£3.4 m in 2015–16, £5.3 m in 2016–17, and £5.6 m in 2017–18). The primary organisation responsible for commissioning health services for the local population (NEHF clinical commissioning group) had an annual budget of £238 m for the financial year 2015–16. |
| 2015 July | Integrated care teams: Five multi-disciplinary teams made up of professionals from primary care, community care, mental health, social care, and the voluntary sector working together to provide more coordinated care through a single care planning process. |
| 2015 August | Study starts |
| 2016 November | Enhanced recovery at home service: A service to facilitate timely discharge and a seamless transition to ongoing care following an unplanned admission to hospital, or to avoid hospital for those who can be supported to remain at home. |
| 2016 November | Ambulatory emergency care: A new unit at the main local hospital providing rapid assessment, diagnosis, and treatment so that, if clinically safe to do so, patients presenting at hospital with relevant conditions can return home the same day their care is provided. Patients treated in the new unit were recorded as being admitted to hospital even if discharged later the same day. |
| 2017 February, and 2017 June | Primary care-led urgent care centres: two new centres providing urgent, same day primary care advice and treatment to patients registered with local GP practices. |
| 2017 March | Rapid home response service: A support service provided by specially trained community paramedics for patients at immediate risk of hospital admission. The team also provides bridging support to enable patients to stay at home while care packages are arranged. |
| 2017 April | 111 GP triage service: A service aimed at reducing the number of non-urgent referrals to ED from the national 111 non-emergency medical helpline by offering patients a call with a GP within 15 minutes of their 111 call. NHS 111 is a national service, but the service model associated with this initiative was different to that being operated in most other parts of England. |
| 2020 February | Study ends |
Figure 1
Counterfactual and intervention averages, and average effect, 65+ year-old population (admissions outcomes and ED visits are rates per 10,000 population per month; average length of stay is days). CACSC = chronic ambulatory care sensitive conditions, UCSC = urgent care sensitive conditions.
Table 2
Average effect (difference between NEHF and estimated counterfactual), 65+ year-old population. Admissions outcomes and ED visits are rates per 10,000 population per month; average length of stay is days. CACSC = chronic ambulatory care sensitive conditions, UCSC = urgent care sensitive conditions.
| OUTCOME VARIABLE | YEAR 1 AUG–15 TO MAR–16 | YEAR 2 2016–17 | YEAR 3 2017–18 | YEAR 4 2018–19 | YEAR 5 APR–19 TO FEB–20 |
|---|---|---|---|---|---|
| All emergency admissions, rate | |||||
| Difference | –8.9 (–18.3 to 1.11) | –1.0 (–15.5 to 12.8) | –17.7 (–32.3 to –4.1) | –4.4 (–21.7 to 13.3) | –22.1 (–42.4 to –1.2) |
| Rel. difference (%) | –4.2 (–8.3 to 0.6) | –0.5 (–7.0 to 6.6) | –8.1 (–13.7 to –2.0) | –2.0 (–9.2 to 6.6) | –9.8 (–17.2 to –0.6) |
| Overnight emergency admissions, rate | |||||
| Difference | –6.3 (–14.8 to 3.7) | –6.9 (–17.0 to 4.1) | –24.1 (–35.7 to –11.9) | –17.1 (–31.1 to –2.1) | –22.3 (–38.8 to –4.5) |
| Rel. difference (%) | –3.7 (–8.3 to 2.3) | –4.1 (–9.6 to 2.6) | –14.0 (–19.4 to –7.4) | –10.1 (–17.0 to –1 .4) | –12.9 (–20.5 to –2.9) |
| CACSC admissions, rate | |||||
| Difference | –2.7 (–5.3 to –0.3) | –1.1 (–4.3 to 1.9) | –4.0 (–6.9 to –0.8) | –3.4 (–6.9 to 0.8) | –5.0 (–9.4 to –0.2) |
| Rel. difference (%) | –12.6 (–21.8 to –1.6) | –5.2 (–17.5 to 10.5) | –17.8 (–27.2 to –4.2) | –14.8 (–26.5 to 4.4) | –19.9 (–32.0 to –1.2) |
| UCSC admissions, rate | |||||
| Difference | –0.2 (–3.7 to 3.1) | 0.6 (–4.6 to 4.5) | –3.3 (–8.7 to 1.3) | –1.8 (–8.1 to 3.3) | –5.9 (–12.7 to 0.0) |
| Rel. difference (%) | –0.4 (–8.0 to 8.0) | 1.4 (–9.9 to 11.9) | –8.1 (–18.6 to 3.6) | –4.4 (–16.9 to 8.9) | –13.5 (–25.2 to 0.0) |
| ED visits, rate | |||||
| Difference | –15.4 (–30.8 to –1.3) | –1.3 (–27.3 to 17.6) | 2.4 (–28.1 to 29.7) | 8.4 (–58.2 to 60.4) | 2.9 (–49.5 to 44.7) |
| Rel. difference (%) | –5.1 (–9.6 to –0.5) | –0.4 (–8.2 to 6.1) | 0.8 (–8.4 to 10.7) | 2.8 (–16.0 to 24.7) | 0.9 (–13.8 to 16.9) |
| Average length of stay overnight emergency admissions, days | |||||
| Difference | 0.7 (–0.2 to 1.7) | 1.5 (0.7 to 2.3) | 1.5 (0.7 to 2.5) | 1.6 (0.6 to 2.6) | 2.0 (1.1 to 2.9) |
| Rel. difference (%) | 6.7 (–1.5 to 16.3) | 13.7 (5.9 to 22.2) | 14.4 (5.7 to 25.5) | 16.0 (5.3 to 29.6) | 19.9 (10.2 to 33.3) |
Figure 2
Average effect (difference between outcome observed in NEHF and estimated counterfactual), 65+ year-old population. Admissions outcomes and ED visits are rates per 10,000 population per month; average length of stay is days. Red = confidence interval does not contain zero, blue = confidence interval contains zero. CACSC = chronic ambulatory care sensitive conditions, UCSC = urgent care sensitive conditions.