Understanding Patterns of Emergency Services Use and Hospital Admissions for Patients of the NHS Case Management Programme

Phillips, Eloise (2018) Understanding Patterns of Emergency Services Use and Hospital Admissions for Patients of the NHS Case Management Programme. Doctoral thesis, Birmingham City University.

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Abstract

As a result of perceived insufficient non-acute care provision, the Government is making efforts to extend primary care hours to reduce the inappropriate utilisation of 999 and A&E services (NHS England, 2013c, 2014b; Kings Fund, 2017). The case management programme was implemented to reduce acute care use in the ageing and multimorbid demographic who are high-intensity service users (DOH, 2005a). However, case management typically has restricted hours of service delivery, which could place unnecessary burden on emergency and acute services during the out-ofhours period. The aim of this study was to understand the patterns of case-managed patients’ use of 999 emergency services and presentations at A&E, and hospital admissions, as well as to explore what factors were perceived as influencing patterns of service interaction.

Within a pragmatic paradigm, a sequential explanatory mixed methods study was deployed, delivered in five studies. Two cross-sectional observational studies analysed 999 callout (n=2,930, study one) and A&E attendance and hospital admission data (n=16,495, study two). Descriptive statistics were applied, and inferential statistics conducted according to data type. Key stakeholders were interviewed (patients n=19, study three, carers n=19, study four) and three focus groups conducted (case managers n=18, study five). Transcripts were analysed via an analysis spiral using both deductive and inductive approaches (Creswell, 2007).

Using a pluralistic framework and previously unexploited flagged patient-level quantitative datasets produced a novel understanding of when, why and how casemanaged patients interact with services. Despite no out-of-hours emergency service burden within studies one and two, twenty-four-hour case management service provision may be required to align with acute services. Quantitative data highlighted that integration and digital interoperability across systems are required to aid admission avoidance and to improve patient experience. Qualitative investigation revealed service contact was seen in places where several parts of the system were seen to be under strain. Person-centred care and shared decision making may also need to be improved when conveyance and admission decisions are made. Case management as a model for admission prevention to manage the ageing and multimorbid population was valued in studies three to five. The inclusion of elderly and housebound participants brought the lived experience of older people to the forefront, highlighting the negative impact of the media in delaying service interactions. This research could be used to inform policy and service-level decisions at the macro- and meso-levels of healthcare. A conceptual model of the factors that contribute to service interaction presents a holistic infographic guide for case management admission prevention.

Item Type: Thesis (Doctoral)
Additional Information: I would like to thank several people to whom I owe a debt of gratitude. Firstly, my supervisory team Dr Sarahjane Jones, Professor Maxine Lintern and Professor Mark Radford for their continued support and tutelage over the past three years. Without all the training and time, you afforded me, I would never have achieved the dream of my career and completed study to PhD level. Initially, I met so many colleagues and fellow nurses who still purveyed the attitude ‘why do we need nurses with PhD’s?’ This only ignited and fevered my drive and determination, so thank you to the nurses who tried to stop me at the first hurdle! Dr Sarahjane Jones has been an inspirational and dedicated supervisor; you shall forever be my role model, and I do not think words could convey how much I would like to thank you for your continued encouragement. To all the NHS staff, patients, carers and patient and public involvement participants who assisted me with the study, I am forever grateful. Without your input and participation none of this would have been possible. Elaine and Ian Phillips, my mum and dad, who have been my cornerstone throughout the process, to whom I also could not have commenced or completed this journey. Thank you for always listening to my moans and helping me financially, spiritually, practically, psychologically and emotionally. I love you both very much. And finally, to all my friends who have had to endure life without me my while I worked seven-days a week, I will be back soon! Thank you for all your uplifting messages and coaching me through this roller-coaster of a journey.
Uncontrolled Keywords: Case Management, Hospital Admission Prevention, Hospital Admission Avoidance, After -Hours Care, Community Care, Community Nursing, Long-Term Conditions, Multimorbidity, Chronic Disease Management,
Subjects: A300 Clinical Medicine
Divisions: REF UoA Output Collections > Doctoral Theses Collection
Depositing User: Kip Darling
Date Deposited: 19 Mar 2019 14:58
Last Modified: 19 Mar 2019 14:58
URI: http://www.open-access.bcu.ac.uk/id/eprint/7270

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