Abstract
BackgroundThe purpose of this study was to assess the relationship between skill mix, patient outcomes, length of stay and service costs in older peoples' intermediate care services in England.MethodsWe undertook multivariate analysis of data collected as part of the National Evaluation of Intermediate Care Services. Data were analysed on between 337 and 403 older people admitted to 14 different intermediate care teams. Independent variables were the numbers of different types of staff within a team and the ratio of support staff to professionally qualified staff within teams. Outcome measures include the Barthel index, EQ-5D, length of service provision and costs of care.ResultsIncreased skill mix (raising the number of different types of staff by one) is associated with a 17% reduction in service costs (p = 0.011). There is weak evidence (p = 0.090) that a higher ratio of support staff to qualified staff leads to greater improvements in EQ-5D scores of patients.ConclusionsThis study provides limited evidence on the relationship between multidisciplinary skill mix and outcomes in intermediate care services.
Highlights
The purpose of this study was to assess the relationship between skill mix, patient outcomes, length of stay and service costs in older peoples’ intermediate care services in England
Extrapolating from the main study findings, it appears that despite large variations in staffing across services, there is little measurable effect on the outcomes for service users. These findings suggest that there may be potential for efficiency savings in intermediate care services through the identification of more effective models of interprofessional team organisation
Quantitative data were collected by staff employed by the intermediate care services according to protocols established by the evaluation team
Summary
The purpose of this study was to assess the relationship between skill mix, patient outcomes, length of stay and service costs in older peoples’ intermediate care services in England. There are several drivers for workforce change including skills shortages; productivity improvements; cost containment; quality improvement; technological innovation; and health sector reform. The modernisation of the National Health Service has led to substantial changes to the numbers and types of staff, and their ways of working. Intermediate care (IC) is a valuable setting in which to explore new ways of working. Many IC services operate at the interface of numerous agencies, settings and professional groups, and require workforce structures that can reflect and respond to this complexity [2]. IC services tend to have non-hierarchical management structures; and staff are often supervised by someone whose professional background is different to their own. IC services can be delivered in a variety of locations, including the patients’ own home, nursing homes, hospitals and community centres
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