title: Understanding the Models of Community Hospital rehabilitation Activity (MoCHA): a mixed-methods study.
abstract: To understand the variation in performance between community hospitals, our objectives are: to measure the relative performance (cost efficiency) of rehabilitation services in community hospitals; to identify the characteristics of community hospital rehabilitation that optimise performance; to investigate the current impact of community hospital inpatient rehabilitation for older people on secondary care and the potential impact if community hospital rehabilitation was optimised to best practice nationally; to examine the relationship between the configuration of intermediate care and secondary care bed use; and to develop toolkits for commissioners and community hospital providers to optimise performance.
  
  
  
  4 linked studies will be performed. Study 1: cost efficiency modelling will apply econometric techniques to data sets from the National Health Service (NHS) Benchmarking Network surveys of community hospital and intermediate care. This will identify community hospitals' performance and estimate the gap between high and low performers. Analyses will determine the potential impact if the performance of all community hospitals nationally was optimised to best performance, and examine the association between community hospital configuration and secondary care bed use. Study 2: a national community hospital survey gathering detailed cost data and efficiency variables will be performed. Study 3: in-depth case studies of 3 community hospitals, 2 high and 1 low performing, will be undertaken. Case studies will gather routine hospital and local health economy data. Ward culture will be surveyed. Content and delivery of treatment will be observed. Patients and staff will be interviewed. Study 4: co-designed web-based quality improvement toolkits for commissioners and providers will be developed, including indicators of performance and the gap between local and best community hospitals performance.
  
  
  
  Publications will be in peer-reviewed journals, reports will be distributed through stakeholder organisations. Ethical approval was obtained from the Bradford Research Ethics Committee (reference: 15/YH/0062).
authors.affiliation: Division of Rehabilitation and Ageing, School of Medicine, University of Nottingham, Nottingham, UK.
authors.forename: John
authors.initials: J
authors.lastname: Gladman
authors.affiliation: School of Public Health, Yale University, New Haven, USA.
authors.forename: John
authors.initials: J
authors.lastname: Buckell
authors.affiliation: Academic Unit of Elderly Care and Rehabilitation, University of Leeds, Leeds, UK.
authors.forename: John
authors.initials: J
authors.lastname: Young
authors.affiliation: Academic Unit of Health Economics, University of Leeds, Leeds, UK.
authors.forename: Andrew
authors.initials: A
authors.lastname: Smith
authors.affiliation: Academic Unit of Health Economics, University of Leeds, Leeds, UK.
authors.forename: Clare
authors.initials: C
authors.lastname: Hulme
authors.affiliation: Academic Unit of Elderly Care and Rehabilitation, University of Leeds, Leeds, UK.
authors.forename: Satti
authors.initials: S
authors.lastname: Saggu
authors.affiliation: Academic Unit of Elderly Care and Rehabilitation, University of Leeds, Leeds, UK.
authors.forename: Mary
authors.initials: M
authors.lastname: Godfrey
authors.affiliation: ScHARR, University of Sheffield, Sheffield, UK.
authors.forename: Pam
authors.initials: P
authors.lastname: Enderby
authors.affiliation: Academic Unit of Elderly Care and Rehabilitation, University of Leeds, Leeds, UK.
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Teale
authors.affiliation: Academic Unit of Health Economics, University of Leeds, Leeds, UK.
authors.forename: Roberto
authors.initials: R
authors.lastname: Longo
authors.affiliation: Academic Unit of Health Economics, University of Leeds, Leeds, UK.
authors.forename: Brenda
authors.initials: B
authors.lastname: Gannon
authors.affiliation: NHS Benchmarking Network, Manchester, UK.
authors.forename: Claire
authors.initials: C
authors.lastname: Holditch
authors.affiliation: The Patients Association, London, UK.
authors.forename: Heather
authors.initials: H
authors.lastname: Eardley
authors.affiliation: The Community Hospitals Association, Ilminster, UK.
authors.forename: Helen
authors.initials: H
authors.lastname: Tucker
mesh_terms: D019985:Benchmarking; D006282:Health Personnel; D006302:Health Services Research; D006764:Hospitals, Community / Q000191:economics*; D006801:Humans; D017059:Models, Econometric; D017146:Models, Organizational; D010361:Patients; D058996:Quality Improvement; D012107:Research Design; D011795:Surveys and Questionnaires; D006113:United Kingdom
keywords: community hospitals; mixed research methods