The role of matched controls in building an evidence base for hospital-avoidance schemes: a retrospective evaluation.
OBJECTIVE
To test whether two hospital-avoidance interventions altered rates of hospital use: "intermediate care" and "integrated care teams."


METHODS
Linked administrative data for England covering the period 2004 to 2009.


METHODS
This study was commissioned after the interventions had been in place for several years. We developed a method based on retrospective analysis of person-level data comparing health care use of participants with that of prognostically matched controls.


METHODS
Individuals were linked to administrative datasets through a trusted intermediary and a unique patient identifier.


RESULTS
Participants who received the intermediate care intervention showed higher rates of unscheduled hospital admission than matched controls, whereas recipients of the integrated care team intervention showed no difference. Both intervention groups showed higher rates of mortality than did their matched controls.


CONCLUSIONS
These are potentially powerful techniques for assessing impacts on hospital activity. Neither intervention reduced admission rates. Although our analysis of hospital utilization controlled for a wide range of observable characteristics, the difference in mortality rates suggests that some residual confounding is likely. Evaluation is constrained when performed retrospectively, and careful interpretation is needed.
Nuffield Trust, London, United Kingdom. adam.steventon@nuffieldtrust.org.uk
Adam
A
Steventon
Martin
M
Bardsley
John
J
Billings
Theo
T
Georghiou
Geraint Hywel
GH
Lewis
D000368:Aged; D000369:Aged, 80 and over; D016022:Case-Control Studies; D019033:Delivery of Health Care, Integrated / Q000458:organization & administration*; D004739:England; D017050:Episode of Care; D005260:Female; D006302:Health Services Research; D006760:Hospitalization; D006801:Humans; D016015:Logistic Models; D008297:Male; D010343:Patient Admission / Q000706:statistics & numerical data*; D010348:Patient Care Team / Q000458:organization & administration*; D015397:Program Evaluation; D012189:Retrospective Studies; D012308:Risk Management; D013222:State Medicine