Contacts
Contact:
Jill Mitchell
Head of Long Term Conditions
Organisation:
NHS North of TyneCommissioning
Centre for Advanced Industry Coble Dene North Shields NE29 6DE United Kingdom
Tel:
0191 2022039
Email:
Case study:
17 August 2007
Community Nursing Hospital Admission Avoidance Programme in Northumberland
Key points
- A community nursing programme in Northumberland has managed to reverse the decline in cancer deaths at home
- The long-term target is to achieve 50% of deaths at home or in community settings. At the end of 2006 the figure was 38%.
A Northumberland-wide community nursing programme has managed in its first year to reverse the decline in the number of cancer deaths taking place at home.
Data analysis over an eight-year period showed that there had been a reduction in the number of cancer patients who died at home or in residential care setting from 40% in 1998 to 33% in 2005.
Six months after the Community Nursing Hospital Admission Avoidance Programme was set up the year-end figure had risen to 38%, an increase of 5% with a reduction in the number of people being admitted to acute hospitals at the end of life.
The practice teams’ longer-term target is to achieve 50% of cancer deaths within the community.
Under the new scheme, launched in the summer of 2006, the aim has been to:
- increase the number of cancer patients dying in their normal place of residence
- reduce the number of cancer patients dying in the acute sector
- maximise the use of community palliative care services and tools of the End of Life Care Programme (LCP, ACP)
The drivers for initiating the project were multi-faceted, including the requirement to contribute to a financial recovery plan.
A working group agreed seven alternative care pathways against which targets could be set.
These were:
- class 2 cellulitis
- exacerbation of COPD
- heart failure with fluid overload
- chest infections/UTIs – elderly
- acute urinary retention
- nursing home admissions
- palliative care admission to acute beds at end of life
Trend analysis at practice level provided an indicator as to how practices teams were managing patients in the community in these categories and reflective case review allowed teams to learn from episodes where patients had been admitted to acute hospital in the past.
A database system was developed (AACE) on which community teams logged each patient whom they prevented from being admitted to hospital together with associated reference costs.
This allows for the cost of the community episode of care to be compared to the average cost of the HRG and an efficiency saving to be identified.
Local systems were also established to monitor progress around the proposed target.
This data is routinely fed back to community teams and practice-based commissioning leads.
As a result the admission avoidance programme has been able to improve the quantity and quality of care delivered in the community at the end of life and turn around the decline in cancer deaths at home.
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