title: An evaluation of the costs and consequences of Children Community Nursing teams.
abstract: OBJECTIVE
  Recent years have seen an increasing shift towards providing care in the community, epitomised by the role of Children's Community Nursing (CCN) teams. However, there have been few attempts to use robust evaluative methods to interrogate the impact of such services. This study sought to evaluate whether reduction in secondary care costs, resulting from the introduction of 2 CCN teams, was sufficient to offset the additional cost of commissioning.
  
  
  METHODS
  Among the potential benefits of the CCN teams is a reduction in the burden placed on secondary care through the delivery of care at home; it is this potential reduction which is evaluated in this study via a 2-part analytical method. Firstly, an interrupted time series analysis used Hospital Episode Statistics data to interrogate any change in total paediatric bed days as a result of the introduction of 2 teams. Secondly, a costing analysis compared the cost savings from any reduction in total bed days with the cost of commissioning the teams. This study used a retrospective longitudinal study design as part of the transforming children's community services trial, which was conducted between June 2012 and June 2015.
  
  
  RESULTS
  A reduction in hospital activity after introduction of the 2 nursing teams was found, (9634 and 8969 fewer bed days), but this did not reach statistical significance. The resultant cost saving to the National Health Service was less than the cost of employing the teams.
  
  
  CONCLUSIONS
  The study represents an important first step in understanding the role of such teams as a means of providing a high quality of paediatric care in an era of limited resource. While the cost saving from released paediatric bed days was not sufficient to demonstrate cost-effectiveness, the analysis does not incorporate wider measures of health care utilisation and nonmonetary benefits resulting from the CCN teams.
authors.affiliation: Centre for Health Economics, University of York, Heslington, UK.
authors.forename: Sebastian
authors.identifier: http://orcid.org/0000-0002-7117-4142
authors.initials: S
authors.lastname: Hinde
authors.affiliation: Health Sciences, University of York, Heslington, UK.
authors.forename: Victoria
authors.initials: V
authors.lastname: Allgar
authors.affiliation: Centre for Health Economics, University of York, Heslington, UK.
authors.forename: Gerry
authors.initials: G
authors.lastname: Richardson
authors.affiliation: Institute of Health & Society, Newcastle University, Newcastle-Upon-Tyne, UK.
authors.forename: Gemma
authors.initials: G
authors.lastname: Spiers
authors.affiliation: Social Policy Research Unit, University of York, Heslington, UK.
authors.forename: Gillian
authors.initials: G
authors.lastname: Parker
authors.affiliation: Social Policy Research Unit, University of York, Heslington, UK.
authors.forename: Yvonne
authors.initials: Y
authors.lastname: Birks
mesh_terms: D001509:Bed Occupancy / Q000191:economics / Q000706:statistics & numerical data; D003153:Community Health Services / Q000191:economics / Q000458:organization & administration* / Q000706:statistics & numerical data*; D003362:Cost-Benefit Analysis; D006801:Humans; D065186:Interrupted Time Series Analysis; D008137:Longitudinal Studies; D009313:National Health Programs / Q000191:economics / Q000458:organization & administration*; D010371:Pediatric Nursing / Q000191:economics / Q000458:organization & administration* / Q000706:statistics & numerical data*; D012189:Retrospective Studies
keywords: bed days; child nursing; community care; cost minimisation; interrupted time series analysis; nursing; quantitative analysis