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Geriatric medicine
Research
Understanding variation in unplanned admissions of people aged 85 and over: a systems-based approach
  1. Andrew Wilson1,
  2. Richard Baker1,
  3. John Bankart1,
  4. Jay Banerjee2,
  5. Ran Bhamra3,
  6. Simon Conroy4,
  7. Stoyan Kurtev1,
  8. Kay Phelps5,
  9. Emma Regen5,
  10. Stephen Rogers6,
  11. Justin Waring7
  1. 1 Health Sciences, University of Leicester, Leicester, UK
  2. 2 Emergency Medicine, University Hospitals of Leicester NHS Trust, Infirmary Square, Leicester, UK
  3. 3 WolfsonSchool of Mechanical, Electrical & Manufacturing Engineering, Loughborough University, Loughborough, UK
  4. 4 Health Sciences, University of Leicester, Leicester, UK
  5. 5 Health Sciences, University of Leicester, Leicester, UK
  6. 6 Health Sciences, University of Leicester, Leicester, UK
  7. 7 Centre for Health Innovation, Leadership & Learning / Nottingham University Business School, University of Nottingham, Nottingham, UK
  1. Correspondence to Professor Andrew Wilson; aw7{at}le.ac.uk

Abstract

Aim To examine system characteristics associated with variations in unplanned admission rates in those aged 85+.

Design Mixed methods.

Setting Primary care trusts in England were ranked according to changes in admission rates for people aged 85+ between 2007 and 2009, and study sites selected from each end of the distribution: three ‘improving’ sites where rates had declined by more than 4% and three ‘deteriorating’ sites where rates had increased by more than 20%. Each site comprised an acute hospital trust, its linked primary care trust/clinical commissioning group, the provider of community health services and adult social care.

Participants A total of 142 representatives from these organisations were interviewed to understand how policies had been developed and implemented. McKinsey’s 7S framework was used as a structure for investigation and analysis.

Results In general, improving sites provided more evidence of comprehensive system focused strategies backed by strong leadership, enabling the development and implementation of policies and procedures to avoid unnecessary admissions of older people. In these sites, primary and intermediate care services appeared more comprehensive and better integrated with other parts of the system, and policies in emergency departments were more focused on providing alternatives to admission.

Conclusions Health and social care communities which have attenuated admissions of people aged 85+ prioritised developing a shared vision and strategy, with sustained implementation of a suite of interventions.

  • older people
  • unplanned admissions
  • health systems
  • mixed methods

This is an open access article distributed in accordance with the Creative Commons Attribution 4.0 Unported (CC BY 4.0) license, which permits others to copy, redistribute, remix, transform and build upon this work for any purpose, provided the original work is properly cited, a link to the licence is given, and indication of whether changes were made. See: https://creativecommons.org/licenses/by/4.0/.

https://doi.org/10.1136/bmjopen-2018-026405

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    Footnotes

    • Contributors All authors contributed to study design and analysis, and have approved the final manuscript. AW led the study, RB and SR contributed expertise in primary care and quality improvement, JBank and SK led on selection of sites. JBane and SC constructed expertise on ED policies and geriatric medicine respectively. RB contributed expertise on system theory and JW led the analysis. KP and ER led on fields work and conducted most of the interviews.

    • Funding The project was funded by the NIHR Health Service and Delivery and Research Programme (project number 10/1010/05). The views and opinions expressed in this article are those of the authors and do not necessarily reflect those of the Health Service and Delivery and Research Programme, NIHR, NHS or the Department of Health.

    • Competing interests None decalred.

    • Ethics approval University of Leicester and R & D approvals fromparticipating organisations

    • Provenance and peer review Not commissioned; externally peer reviewed.

    • Data sharing statement Full transcripts are available from the corresponding author.

    • Patient consent for publication Not required.