Solid data bears comparison

How do you decide whether an existing intermediate care service is suitable for patients in an acute hospital waiting for supported discharge? Data - specifically, healthcare assessment data.

In one trust in the South East, intermediate care was seen as the only affordable alternative despite doubts about its effectiveness. So it commissioned research. The objective of the study, by Senectus, working out of the centre for health services studies at Kent University, was to compare health profiles to see whether patients waiting for hospital discharge had care needs analogous to those of intermediate care patients. If so, safe continuity of care could be expected.

Intermediate care eases the transition between hospital and home, provides rehabilitation and acts as an alternative to long-term care. It gears itself to specific local applications, meaning these care services are not 'one size fits all'.

Planners are rightly cautious when considering introducing a new client group into an existing service. There must be evidence and data.

This is not a new concept. Standardised assessment underpinned the national service framework for older people and has acted as a key driver for the many associated initiatives, including the single assessment process (SAP).

Which tools?
So which tools should you use and how? One of the SAP tools accredited by the Department of Health is the minimum data set (MDS) developed by interRAI-UK. It uses key health profile subscales. For each subscale, patients are assigned a score calculated from their assessment results. All subscales have been researched and have known validity and reliability, providing meaningful measures of a person's health status.

For the Senectus study, hospital and intermediate care staff were trained in the MDS system and 100 assessments were done across the two sites. Subscale scores for each patient were calculated for physical function, cognitive function, mood state, resource usage and medical instability. Scores were then compiled and compared.

Although approximately half of the patients in each group were found to be physically independent, a significantly greater number of intermediate care admissions required help rather than just supervision with daily activities. In other words, intermediate care was already catering for a slightly more physically dependent group than those awaiting hospital discharge.

There was no significant difference in cognitive impairment levels between the two groups.

Comparing mood state, a small but significant number of intermediate care patients was categorised as 'potentially depressed', unlike those in the hospital group.

Statistical comparison of resource usage found no care need difference between the two groups.

To define medical stability (the state in which patients must be judged to be before discharge) the MDS uses a system based on a number of assessment variables: changes in health, end-stage disease, and signs and symptoms (CHESS). The CHESS scores showed a significant difference among the patients in the project, although it was the hospital patients who had a greater degree of medical stability.

The overarching message from the comparisons is that, for each measure, hospital discharge patients were found to be either the same as or better than current intermediate care admissions.

Specific differences aside, planners could be confident that local intermediate care was already geared to accept patients in at least as severe a condition as those awaiting hospital discharge.

Where there were differences, the data will enable healthcare professionals to gauge the extent to which individuals are suited to the intermediate care available as well as guide planners in fine-tuning it to fit best the needs of delayed hospital discharges as a whole.

Mathew Mackenzie is a research associate and Marion Scholes a research assistant at Kent University'³ centre for health services studies.