title: Anticipatory care planning and integration: a primary care pilot study aimed at reducing unplanned hospitalisation.
abstract: BACKGROUND
  Anticipatory care for older patients who are frail involves both case identification and proactive intervention to reduce hospitalisation.
  
  
  OBJECTIVE
  To identify a population who were at risk of admission to hospital and to provide an anticipatory  care plan (ACP) for them and to ascertain whether using primary and secondary care data to identify this population and then applying an ACP can help to reduce hospital admission rates.
  
  
  METHODS
  Cohort study of a service intervention in a general practice and  a primary care team in Scotland.
  
  
  METHODS
  The ACP sets out patients' wishes in the event of a sudden deterioration in health. If admitted, a proactive approach was taken to transfer and discharge patients into the community. Cohorts were selected using the Nairn Case  Finder, which matched patients in two practices for age, sex, multiple morbidity indexes, and secondary care outpatient and inpatient activity; 96 patients in each practice were studied for admission rate, occupied bed days and survival.
  
  
  RESULTS
  Survivors from the ACP cohort  (n = 80) had 510 fewer days in hospital than in the 12 months pre-intervention: a significant reduction of 52.0% (P = 0.020). There were 37 fewer admissions of the survivors from that cohort post-intervention than in the preceding 12 months, with a significant reduction of 42.5%  (P = 0.002). Mortality rates in the two cohorts were similar, but the number of patients who died in hospital and the hospital bed days used in the last 3 months of life were significantly lower for the decedents with an ACP than for the controls who had died (P = 0.007 and P  = 0.045 respectively).
  
  
  CONCLUSIONS
  This approach produced statistically significant reductions in unplanned hospitalisation for a cohort of patients with multiple morbidities. It demonstrates the potential for providing better care for patients as well as better value for  health and social care services. It is of particular benefit in managing end-of-life care.
authors.affiliation: Lodgehill Clinic, Nairn, UK. adrian.baker@nhs.net
authors.forename: Adrian
authors.initials: A
authors.lastname: Baker
authors.forename: Paul
authors.initials: P
authors.lastname: Leak
authors.forename: Lewis D
authors.initials: LD
authors.lastname: Ritchie
authors.forename: Amanda J
authors.initials: AJ
authors.lastname: Lee
authors.forename: Shona
authors.initials: S
authors.lastname: Fielding
mesh_terms: D000369:Aged, 80 and over; D001509:Bed Occupancy; D017281:Cost of Illness; D005260:Female; D058006:General Practice / Q000458:organization & administration*; D017721:Hospital Costs; D017052:Hospital Mortality; D006760:Hospitalization / Q000191:economics / Q000706:statistics & numerical data*; D006801:Humans; D007902:Length of Stay; D008297:Male; D010347:Patient Care Planning / Q000458:organization & administration*; D010348:Patient Care Team / Q000458:organization & administration*; D057240:Patient Preference; D010360:Patient Transfer; D010865:Pilot Projects; D012606:Scotland