Abstract
Introduction Supporting frail older people at home is an international policy objective. This article explored variations in care coordination arrangements and their relationship with service level outcomes using England as a case study. Method Survey data and routinely generated data collected in 2006 from 119 local authorities responsible for social care were combined. Using cluster analysis, distinct groups were identified with regard to forms of care coordination. Results Considerable variation was evident both within and between different types of care coordination, reflecting implementation guidance. Links with service level outcomes were weak, the most notable being the provision of intensive home care, a component of intensive care management. Discussion Thus this study, using agency level data, confirmed the variability in care coordination arrangements and the relative absence of intensive care management, central to shifting the balance of care from residential and nursing provision to care at home.
Highlights
Care management, a precursor of care coordination, has been a feature of services for older people in many countries since its initial development in North America and subsequent development in the United Kingdom (UK) and elsewhere (Béland et al, 2006; Bernabei et al, 1998; Challis and Davies, 1986; Challis et al, 2009; Kemper, 1990; Leung et al, 2004a)
Cluster analysis was used to explore the complexities of care coordination arrangements that have evolved in England
Reflecting the discretionary guidance that accompanied the community care reforms, considerable variation in care coordination arrangements were noted with no one type predominating
Summary
A precursor of care coordination, has been a feature of services for older people in many countries since its initial development in North America and subsequent development in the United Kingdom (UK) and elsewhere (Béland et al, 2006; Bernabei et al, 1998; Challis and Davies, 1986; Challis et al, 2009; Kemper, 1990; Leung et al, 2004a). It was introduced to enable the support of people in community-based care rather than institutional care because of the need to find cost-effective alternatives for those with complex needs requiring long-term care and to coordinate fragmented services (Applebaum and Austin, 1990; Cm 849, 1989; Davies and Challis, 1986; Ministry of Health, Welfare and Sports, 2007; Minkman et al, 2009; Moxley, 1989). Different approaches to care coordination have emerged in England replicating developments elsewhere (Challis et al, 1998; Geron, 2000; Minkman et al, 2009; Newcomer et al, 1997; Weiner et al, 2002; Wistow, 2012)
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