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Aberdeenshire Staywell - Reducing hospital admissions and bed days for patients with long term conditions

Challenge

In common with all its NHS counterparts throughout the UK, Aberdeenshire CHP has the challenge of reducing unscheduled hospital admissions and bed days for patients within its community. It has developed a new anticipatory care programme, particularly focused on patients with long term conditions such as COPD. In putting together this programme, the team realised it lacked a suitable self care education tool that could be widely and cost-effectively deployed.

Solution

Two years ago, Aberdeenshire licensed and deployed Intouch’s “Staywell” Self Care Education Programme around a number of its GP practices, district nurses, re-hab teams and community hospital. Patients are invited to participate online or on paper. The initial focus has been on COPD, diabetes and health of the elderly.

The CHP team have been particularly keen to measure the impact of Staywell on hospital admissions and bed days, and also to see how it can increase productivity in primary care.

Results

 

 

 

The table below compares admissions and bed days statistics for Peterhead (the largest practice in the UK in terms of patient numbers) with a number of "control" practices which have similar patient demographics. Peterhead has Staywell as an integral element of its COPD care pathway, the control practices do not, but all other approaches to the management of COPD patients are similar. These are early days results and more statistics are now being gathered for a greater number of Staywell practices.

 

BED DAYS

• Occupied Bed Day rate per 100,000 for Peterhead Sept ’08 2410.1
• Occupied Bed Day rate per 100,000 for Peterhead Sept ’09 1723.0

Reduction of 687.1 Occupied Bed Days per 100,000 (- 28% Staywell)

• Occupied Bed Day rate per 100,000 for comparison sites Sept ’08 1714.5
• Occupied Bed Day rate per 100,000 for comparison sites Sept ’09 2353

Increase of 638.5 Occupied Bed Days per 100,000 (+32.2% normal)

 

ADMISSIONS

• Admission Rate per 100,000 for Peterhead Sept ’08 289.2
• Admission Rate per 100,000 for Peterhead Sept ’09 253

Reduction of 36.2 admissions per 100,000 (-12.5% Staywell)

• Admission Rate per 100,000 for comparison sites Sept ’08 151.6
• Admission Rate per 100,000 for comparison sites Sept ’09 196

Increase of 44.4 in admissions per 100,000 (+ 29.8% normal)

The adoption of Staywell Diabetes has resulted in a QoF-related scheme to improve productivity in primary care. The strategy is that any diabetes patient who completes the Staywell self-management knowledge audit at least twice in a year, and who achieves what is defined as an acceptably good score, will earn QoF points for the practice WITHOUT the patient having to attend surgery for an annual health check.

The nurse time saved in this way is then used with those patients who score badly in regard to their self care competence and who are therefore at most risk of requiring crisis care.