Does proactive care in care homes improve survival? A quality improvement project.
BMJ Open Qual
; 13(2)2024 Jun 04.
Article
en En
| MEDLINE
| ID: mdl-38834371
ABSTRACT
BACKGROUND:
NHS England's 'Enhanced Health in Care Homes' specification aims to make the healthcare of care home residents more proactive. Primary care networks (PCNs) are contracted to provide this, but approaches vary widely challenges include frailty identification, multidisciplinary team (MDT) capability/capacity and how the process is structured and delivered.AIM:
To determine whether a proactive healthcare model could improve healthcare outcomes for care home residents. DESIGN ANDSETTING:
Quality improvement project involving 429 residents in 40 care homes in a non-randomised crossover cohort design. The headline outcome was 2-year survival.METHOD:
All care home residents had healthcare coordinated by the PCN's Older Peoples' Hub. A daily MDT managed the urgent healthcare needs of residents. Proactive healthcare, comprising information technology-assisted comprehensive geriatric assessment (i-CGA) and advanced care planning (ACP), were completed by residents, with prioritisation based on clinical needs.Time-dependent Cox regression analysis was used with patients divided into two groupsControl group received routine and urgent (reactive) care only.Intervention group additional proactive i-CGA and ACP.RESULTS:
By 2 years, control group survival was 8.6% (n=108), compared with 48.1% in the intervention group (n=321), p<0.001. This represented a 39.6% absolute risk reduction in mortality, 70.2% relative risk reduction and the number needed to treat of 2.5, with little changes when adjusting for confounding variables.CONCLUSION:
A PCN with an MDT-hub offering additional proactive care (with an i-CGA and ACP) in addition to routine and urgent/reactive care may improve the 2-year survival in older people compared with urgent/reactive care alone.Palabras clave
Texto completo:
1
Colección:
01-internacional
Banco de datos:
MEDLINE
Asunto principal:
Mejoramiento de la Calidad
Límite:
Aged
/
Aged80
/
Female
/
Humans
/
Male
País/Región como asunto:
Europa
Idioma:
En
Revista:
BMJ Open Qual
Año:
2024
Tipo del documento:
Article