Abstract
Background: Intermediate care (IC) is short-term care aimed at maximising patients’ independence. Across the UK, scaling up IC is included in post-pandemic recovery plans. This could reduce pressures on acute services through timely discharge or preventing admissions, and aid with the UK government's goal of moving care from hospitals to the community. The issues IC seeks to address are common across high-income countries.
The Networked Data Lab (NDL) is a network of analytical teams embedded in the UK health and care system. Each year, we support five local partners with acquisition, linkage and analysis of health and social care datasets. Our 2023-24 project was focused on intermediate care. This work consisted of a national-level analysis of step-down (post-hospital discharge) IC in England using linked hospital and community services data (in collaboration with the Strategy Unit), and five local-level analyses of IC conducted by the NDL partner sites. In these analyses, we sought to describe the demographic and health characteristics of the IC-receiving population, explore people’s pathways through and outcomes following IC, and examine how IC services have changed over time.
Approach: Patients and the public (PP) played an integral role in throughout our project. We established a panel of individuals with lived experience of IC to assist with the research questions, interpretation, and communication of results. Our partners all consult PP in their areas to inform their analyses.
The NDL’s analyses of intermediate care were retrospective observational studies using linked patient-level data on IC. Descriptive statistics were produced on the demographic and health profiles of people receiving intermediate care, as well the intensity of intermediate care packages and rates of readmission to hospital following the receipt of IC. Logistic regression was used to explore factors related to the likelihood of receiving intermediate care and of readmission to hospital. Negative binomial regression was used to explore factors associated with the intensity of intermediate care packages, while Cox regression was used to explore time-to-readmission.
Results:
Key results include:
- 40% of step-down intermediate care episodes in England resulted in a hospital admission within 6 weeks
- The age and health needs of people receiving bed-based intermediate care has increased over time (Grampian, Scotland)
- Intermediate care following a hospital admission is more common for emergency admissions than elective admissions (Leeds, England)
- There is large variation in the quantity of intermediate care delivery between neighbouring London boroughs (North-West London, England)
Conclusion : Our results suggest that there is a tension between getting patients out of hospital as quickly as possible and preventing readmissions, which is evident from the high readmission rates and health profiles of people receiving intermediate care. Better data recording and sharing is also needed so we can better understand whether intermediate care is delivering on its ambitions and make the case for change.