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Working Together to Improve Services for Older People

teamThe Institute for Healthcare Improvement published an improvement report that described the results of a two year program with the goal of “promoting independence in the London community of older people, through the delivery of person-centered, coordinated services.” They identified vulnerable seniors at risk in the community, setup a single, multi-agency, multi-disciplinary assessment system and co-ordinated services and then monitored responses from the professionals and the seniors. One important aspect was that they involved state, private and volunteer organizations. They agreed upon a number of performance parameters that were monitored and reported on each month.

The results were impressive and are relevant to the senior community and caregivers alike, both in countries with state welfare systems and those, like the USA, without. One key point is the recognition that “Older people need the whole system working as they tend to have multiple problems. Many of the underlying problems that lead to hospital entry and ill health are not just medical ones.” They screened and supported almost 10,000 seniors at risk within the first fifteen months of operation.

They came up with a wide range of initiatives, including:

  • Targeted screening, early detection and treatment
  • Intensive care management of all of the issues leading to admissions.
  • Reducing delays in the system, from admission processing to updating the seniors’ physicians after hospitalization or other treatments.
  • Speeded service provision through direct referrals and combined referral forms.
  • Protocols that allow one agency to commission specific services from another without re-assessment.
  • Joint cross-agency and disciplinary training. This involved consultants, doctors, hospital nurses, occupational therapists, physiotherapists, rehabilitation workers, social workers, pharmacists, health visitors, district nurses, housing and voluntary sector staff, as well as users and caregivers.
  • Multi-skill training to improve the ability of all services to recognize the need for help from other disciplines.
  • Improved decision-assisting information for all participants.
  • Improved networking within local and similar services.
  • Empowering front line staff to make decisions that err on the safe side without administrative repercussions.
  • Improved services for people from minority communities, including improved access, information, translation/interpreting and health promotion, and more culturally sensitive assessment tools and services.

They reduced the number of attendances at hospitals and physician surgeries by preventing unnecessary visits and by reducing the overall number of days spent in treatment, especially expensive emergency or hospital care. Overall:

  • Hospital admissions dropped by 47 percent.
  • The number of nights spent in hospital went down by 48 percent.
  • Accident and Emergency Room attendances went down by 53 percent.
  • General Practitioner home(!) visits went down by 53 percent.
  • Physician’s out-of-hours service went down by 82 percent.
  • Physician appointments went down by 19 percent.
  • Length of hospital stay was reduced by an average of ten nights per patient.
  • Re-admission of people over 75 years was reduced by 3 percent as compared with the previous year.

The study showed that collaborative projects can be led by a whole range of agencies and staff. The Project Managers had health, social care, voluntary sector and housing backgrounds. My favorite point made by the authors of the study was that “They also demonstrated that service improvement work with older people is essential and can also be cutting edge and fun.”

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