Interrupted time series evaluation of the impact of a dementia wellbeing service on avoidable hospital admissions for people with dementia in Bristol, England.
| Title: | Interrupted time series evaluation of the impact of a dementia wellbeing service on avoidable hospital admissions for people with dementia in Bristol, England. |
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| Authors: | Jones T; National Institute for Health and Care Research Applied Research Collaboration West (NIHR ARC West), University Hospitals Bristol and Weston NHS Foundation Trust, Bristol, UK.; Redaniel MT; National Institute for Health and Care Research Applied Research Collaboration West (NIHR ARC West), University Hospitals Bristol and Weston NHS Foundation Trust, Bristol, UK.; Ben-Shlomo Y; National Institute for Health and Care Research Applied Research Collaboration West (NIHR ARC West), University Hospitals Bristol and Weston NHS Foundation Trust, Bristol, UK. |
| Source: | Journal of health services research & policy [J Health Serv Res Policy] 2023 Oct; Vol. 28 (4), pp. 262-270. Date of Electronic Publication: 2023 Mar 23. |
| Publication Type: | Journal Article; Research Support, Non-U.S. Gov't |
| Language: | English |
| Journal Info: | Publisher: Sage Country of Publication: England NLM ID: 9604936 Publication Model: Print-Electronic Cited Medium: Internet ISSN: 1758-1060 (Electronic) Linking ISSN: 13558196 NLM ISO Abbreviation: J Health Serv Res Policy |
| Imprint Name(s): | Publication: Jan. 2013 - : London : Sage; Original Publication: Edinburgh ; New York : Churchill Livingstone, c1996- |
| MeSH Terms: | Dementia*/epidemiology ; Dementia*/therapy ; Hospitalization*; England/epidemiology ; Humans ; Interrupted Time Series Analysis ; Hospitals |
| Abstract: | Objectives: To determine whether a dementia wellbeing service (DWS) signposting people with dementia to community services decreases the rate of avoidable hospital admissions, in-hospital mortality, complexity of admissions (number of comorbidities) or length of stay.; Methods: Interrupted time series analysis to estimate the effects of the DWS on hospital outcomes. We included all unplanned admissions for ambulatory care sensitive conditions ('avoidable hospital admissions') with a dementia diagnosis recorded in the Hospital Episode Statistics. The intervention region was compared with a demographically similar control region in the 2 years before and 3 years after the implementation of the new service (October 2013 to September 2018).; Results: There was no strong evidence that admission rates reduced and only weak evidence that the trend in average length of stay reduced slowly over time. In-hospital mortality decreased immediately after the introduction of the dementia wellbeing service compared to comparator areas (x0.64, 95% CI 0.42, 0.97, p = 0.037) but attenuated over the following years. The rate of increase in comorbidities also appeared to slow after the service began; they were similar to comparator areas by September 2018.; Conclusions: We found no major impact of the DWS on avoidable hospital admissions, although there was weak evidence for slightly shorter length of stay and reduced complexity of hospital admissions. These findings may or may not reflect a true benefit of the service and require further investigation. The DWS was established to improve quality of dementia care; reducing hospital admissions was never its sole purpose. More targeted interventions may be required to reduce hospital admissions for people with dementia. |
| Grant Information: | NIHR200181 United Kingdom DH_ Department of Health |
| Contributed Indexing: | Keywords: avoidable admissions; dementia; health services evaluation |
| Entry Date(s): | Date Created: 20230323 Date Completed: 20230925 Latest Revision: 20230926 |
| Update Code: | 20260130 |
| DOI: | 10.1177/13558196231164317 |
| PMID: | 36951934 |
| Database: | MEDLINE |
Journal Article; Research Support, Non-U.S. Gov't