title: Continuous monitoring of emergency admissions of older care home residents to hospital.
abstract: BACKGROUND
  evidence from inspection programmes suggest that the quality of care provided by individual care homes for older people is very variable. Aside from periodic inspection, there is limited information that is routinely collected and can be used to monitor quality.
  
  
  OBJECTIVE
  to describe a method for using routine hospital data on admissions of older people as means for monitoring quality of care within a care home. To explore how this might be applied and used.
  
  
  METHODS
  we linked hospital admissions to care homes using postcode matching and analysed hospital admission data as a time series, using the Cumulative Sum (CUSUM) technique to detect unusually high rates of admission.
  
  
  RESULTS
  if we develop the CUSUM so that the number of times it falsely signals a high rate of admissions is limited to a rate of 0.1% per year, the chances of successfully detecting a doubling of the admission rate within 2 years will range from 48% for the smaller homes to 96% for the larger homes.
  
  
  CONCLUSIONS
  monitoring tools using data on admissions to hospital are both possible and feasible, particularly for the larger homes. However, due to data limitations, users need to be careful about how they interpret triggers and thus ensure follow-up is appropriate. Some of the problems caused by using routine national data can be overcome if care homes used their own information for local monitoring.
authors.affiliation: Nuffield Trust-Research, London W1G 7LP, UK.
authors.forename: Chris
authors.initials: C
authors.lastname: Sherlaw-Johnson
authors.affiliation: Nuffield Trust-Research, London W1G 7LP, UK.
authors.forename: Paul
authors.initials: P
authors.lastname: Smith
authors.affiliation: Nuffield Trust-Research, London W1G 7LP, UK.
authors.forename: Martin
authors.initials: M
authors.lastname: Bardsley
mesh_terms: D000367:Age Factors; D000368:Aged; D004636:Emergency Service, Hospital / Q000639:trends*; D005240:Feasibility Studies; D005853:Geriatrics / Q000639:trends*; D006707:Homes for the Aged / Q000639:trends*; D006801:Humans; D010343:Patient Admission / Q000639:trends*; D010360:Patient Transfer / Q000639:trends*; D019984:Quality Indicators, Health Care / Q000639:trends*; D015203:Reproducibility of Results; D013997:Time Factors
keywords: CUSUM; care homes; older people; outcomes; quality of care