title: A whole system study of intermediate care services for older people.
abstract: BACKGROUND
  Intermediate care (IC) services have been widely introduced in England and have the strategic objectives of reducing hospital and long-term care use. There is uncertainty about the clinical outcomes of these services and whether their strategic aims will be realised.
  
  
  METHODS
  A metropolitan city in northern England.
  
  
  METHODS
  A quasi-experimental study comparing a group of older people before and after the introduction of an IC service. A quota sampling method was used to match the groups.
  
  
  METHODS
  Patients presenting as emergency admissions to two elderly care departments with falls, confusion, incontinence or immobility.
  
  
  METHODS
  a city-wide service in which a joint care management team (multi-agency, multi-disciplinary) assessed patient need and purchased support and rehabilitation from sector-based IC teams.
  
  
  RESULTS
  Nottingham Extended Activities of Daily Living score, Barthel Index, Hospital Anxiety and Depression score, mortality, readmission to hospital, and new institutional care placement at 3, 6 and 12 months post-recruitment.
  
  
  RESULTS
  There were 800 and 848 patients, respectively, in the control and intervention groups. Clinical outcomes, hospital and long-term care use were similar between the groups. Uptake of IC was lower than anticipated at 29%. An embedded case-control study comparing the 246 patients who received IC with a matched sample from the control group demonstrated similar clinical outcomes but increased hospital bed days used over 12 months (mean +8 days; 95% CI 3.1-13.0).
  
  
  CONCLUSIONS
  This city-wide IC service was associated with similar clinical outcomes but did not achieve its strategic objectives of reducing long-term care and hospital use.
authors.affiliation: Nuffield Institute for Health, Leeds, UK. john.young@bradfordhospitals.nhs.uk
authors.forename: John B
authors.initials: JB
authors.lastname: Young
authors.forename: Mike
authors.initials: M
authors.lastname: Robinson
authors.forename: Sue
authors.initials: S
authors.lastname: Chell
authors.forename: Diana
authors.initials: D
authors.lastname: Sanderson
authors.forename: Stephen
authors.initials: S
authors.lastname: Chaplin
authors.forename: Eileen
authors.initials: E
authors.lastname: Burns
authors.forename: Jon
authors.initials: J
authors.lastname: Fear
mesh_terms: D000058:Accidental Falls; D000368:Aged; D000369:Aged, 80 and over; D003221:Confusion / Q000628:therapy; D004739:England; D005260:Female; D006299:Health Services for the Aged / Q000592:standards*; D049671:History, 18th Century; D006760:Hospitalization / Q000706:statistics & numerical data; D006801:Humans; D007380:Intermediate Care Facilities / Q000592:standards*; D007902:Length of Stay; D008134:Long-Term Care / Q000706:statistics & numerical data; D008297:Male; D009069:Movement Disorders / Q000628:therapy