The first national study to examine the characteristics and mortality rates of patients in community hospitals in England has found they were mainly an older people living with multiple conditions and over one in four died within a year of their admission. The findings, published in BMC Medicine, also highlighted the traditional emphasis on rehabilitation and recovery for patients in community hospitals has changed with an ageing population and the need for greater integration of palliative care.
The study aimed to examine the characteristics of patients admitted to community hospitals in England who died within a year of their admission and the factors associated with their death.
Community hospitals care for people in transition between hospital and home. They have a key role in managing care for our ageing populations to support recovery following a stressor event and plan for and anticipate end of life. This is the first national study to examine the patient population using community hospitals in England. The findings can help identify policy and clinical priorities for the delivery of high-quality care.
The study involved 76,704 adults admitted to 220 community hospitals over a one-year period in 2016 and used national NHS data on hospital admissions linked with death registration data. The study found patients in this group were on average 81 years and living with multiple chronic progressive conditions. 77% of patients had an unplanned hospital admission. Over one in four patients died within a year of being admitted to a community hospital. The risk of dying increased in those with multiple conditions, cancer and noncancer respiratory conditions, dementia, and liver disease. The study findings showed a shift in the emphasis of care in community hospitals to better meet the needs of this patient group. With an ageing population, the traditional focus on rehabilitation and recovery has changed with need for greater integration of palliative care to adjust care towards quality of life and anticipate and plan for end of life.
The study was led by Dr Catherine Evans, Clinical Reader in Palliative Care and Honorary Nurse Consultant Sussex Community NHS Foundation Trust. It is part of the research carried out by the Symptom and Psychosocial Assessment and Communication Evaluation (SPACE) group, a joint project between the Cicely Saunders Institute of Palliative Care, Policy & Rehabilitation at King’s College London and Sussex Community NHS Foundation Trust. It is funded by a Health Education England/National Institute for Health Research (HEE/NIHR) Senior Clinical Lectureship held by Dr Evans.
The research team concluded the wide variation in end of life indicates the need for care and treatment to support both recovery and plan for and anticipate end of life. The findings challenge views of community hospitals, with relatively low technology, as managing seemingly simplistic care needs. To deliver high quality care requires a model of integrated care between community hospitals, geriatric care and palliative care, and a skilled workforce to manage multiple care needs across the continuum of care and into end of life.
Patients admitted to community hospitals are in transition between hospital and home require intermediate care. Our research showed this group were mainly older people with chronic progressive disease and multiple conditions. Over one in four were in the last year of life. Our findings revealed requirement for integrated geriatric and palliative care to support these patients with multiple care needs. Understanding care needs at a population level is vital to identify policy priorities to deliver high quality care. This work adds to the growing body of evidence of the need for more integrated and joined up models of care among our health services.– Dr Catherine Evans, Chief Investigator