Hospital admissions plummet in integrated care pilots

Well-managed integrated care can reduce hospital admissions for elderly patients by at least a fifth, new research suggests.

A two-year study, commissioned by the Department of Health, involved 16 sites across England which formed its Integrated Care Pilot programme. These sites piloted different ways of integrating care, such as between general practices, community nurses, hospitals and social services.

The research, carried out by Ernst & Young, RAND Europe and the University of Cambridge, analysed staff and patient views on the work of the pilots as well as the impact on hospital admissions and lengths of stay in hospital.

Overall, findings showed that 54% of staff involved thought patient care had improved as a result of the pilots, while 72% reported that they had better communication with other organisations.

In pilots where case managers were appointed to coordinate the care of elderly patients at risk of hospital admission, outpatient visits decreased by 22% and planned admissions by 21%. This led to an overall fall of 9% in the cost of hospital care.

However, the study also concluded that integrated care initiatives would not necessarily save money in the long run. It showed too, that patient satisfaction did not increase.

Compared to before the pilots, 28% fewer patients felt their GP had involved them in decisions about their care, and 9% fewer said they saw the GP they wanted to at their surgery.

The report said: “Patients did not, in general, share the sense of improvement. This could have been because the process changes reflected the priorities and values of staff; because the benefits had not yet become apparent to service users; because of poor implementation; or because the interventions were an ineffective way to improve patient experience.”

Commenting on the pilots, care services minister Paul Burstow said: “This report is an important wake-up call, showing that actioning more integration is challenging even when organisations volunteer to collaborate. Our health reforms put in place the legal framework to support greater integration but to succeed it will require leadership at every level.”