An evaluation of intermediate care services for older people: Summary report

Intermediate care is defined as a range of integrated services designed to promote faster recovery from illness, prevent unnecessary admissions to hospital and long term care, support timely discharge and maximise independent living. It is a vital component of the programme to improve the health and well–being of older people and raise the quality of healthcare they receive. Evaluation of the extent to which intermediate care services (ICS) can achieve these objectives is important given the expectation for and investment in them. Conventional wisdom is that the best approaches to service evaluation are randomised controlled trials and systematic reviews of the literature. However these methods are difficult to use for intermediate care services; because of the differences between the elements of health and social care services, the varying characteristics of the population they serve, the multiple problems and chronic disease of elderly people, and the problems of interaction with other services that may be changing.

The aim of the ICON project was to explore ICS using a whole systems approach to examine the relationship between different ICS and the use of hospital beds and intermediate care resources. To overcome the difficulties of evaluation computer simulation techniques were used. The goal was to develop a computer model that would provide a generalisable system for evaluating intermediate care services. The project took place in the Shepway District of Kent, while ICS were being developed. They included hospital inpatient rehabilitation beds, a Community Assessment and Rehabilitation Team (CART), a recuperative care service and a Day Hospital. Rapid Response Teams have recently been introduced and are being evaluated separately from the ICON project. To develop the computer model, all health and social care services relevant to older people in Shepway were mapped, along with the resources currently available to each. Interviews with service managers provided data on the numbers of staff and beds, admission criteria, and resource use. Patient information was gathered by health care assessments using assessment items from the interRAI Minimum Data Set for Home Care Assessment system (MDS-HC). The assessments included structured health care data on patients, describing their medical, physical, psychological and social characteristics.