出版社：Utrecht University, Maastricht University, Groningen University
摘要：Introduction : 62% of hospital bed days are occupied by older adults 65 and older in the UK and it is estimated that there is a cost to the NHS of £820 million1. Elderly patients admitted to hospital have worse morbidity and mortality outcomes and often have a poorer experience2,3,. To reduce emergency admissions Tameside and Glossop Integrated Care NHS Foundation Trust developed a Digital Health Service, which supports frail people to stay within the community where their care can be managed, avoiding an Emergency room attendance and potential emergency admission. Practice change : To enhance the value of care provided to the local community a digital health service has been implemented in care homes. The service provides digital technology that enables care home staff to access a hospital specialist for advice and guidance on residents who have a deterioration in health before considering an Ambulance/ GP visit. Aim and theory of change : The aim is to use technology to enable care home staff to maintain older people with complex co-morbidities, within their home setting and avoiding unnecessary hospital admissions. Timeline : The programme was launched in March 2017 and will run for 3 years Highlights : In the period April and September 2017 94 Emergency and 258 GP attendances were avoided. Total hospital bed days saved 1268. Deflection rate of Emergency room attendance is currently 70% Comments on sustainability : The programme has now been expanded across the whole of the residential care home sector and will launched as a 24/7 service this year. Limitations : Awaiting more long term finding, ongoing evaluation is required to ensure that early results are sustainable overtime. Comments on transferability A joint End of Life bid is being developed. Conclusions : Elderly people suffer worsening health and poor experience when in hospital 3, 5. There is also a significant financial cost to systems treating frail elderly patients in hospitals 3. The Digital health programme enabled care staff to access acute hospital specialists for advice and guidance, which has led to a significant deflection in attendance. Discussions : The programme has proven successful at reducing admissions and in Emergency room attendance within the population group, data appears to show that the service has the potential to support people to remain within their place of residence rather than be treated in hospital. Lessons learned : General practitioners are key influencers within community setting and proved key to promoting and service References : 1- National Audit Office NAO 2016 Discharging older patients from hospital [online]. Accessed 14 Oct 2017 https://www.nao.org.uk/report/discharging-older-patients-from-hospital 2- Francis, R. Report of the Mid Staffordshire NHS Foundation Trust Public Inquiry: executive summary. 2013. London: Stationery Office, February 6th 2013. ISBN: 9780102981476 3- NHS England 2014 Safe, compassionate care for frail older people using an integrated care pathway: Practical guidance for commissioners, providers and nursing, medical and allied health 4- Ellis, G., Whitehead, M.A., Robinson, D., O’Neill, D., Langhourne, P. Comprehensive geriatric assessment for older adults admitted to hospital: meta analysis of randomised controlled trials. BMJ 2011 Oct 27;343:d6553.doi 10.1136/bmj.d6553
关键词：digital health ; integration ; care outside hospital ; place based ; fraility
