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首页> 外文期刊>BMC Health Services Research >Comparison of the impact of two national health and social care integration programmes on emergency hospital admissions
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Comparison of the impact of two national health and social care integration programmes on emergency hospital admissions

机译：两种国家卫生和社会关怀整合方案对急诊医院招生影响的比较

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Policy-makers expect that integration of health and social care will improve user and carer experience and reduce avoidable hospital use. We evaluate the impact on emergency hospital admissions of two large nationally-initiated service integration programmes in England: the Pioneer (November 2013 to March 2018) and Vanguard (January 2015 to March 2018) programmes. The latter had far greater financial and expert support from central agencies. Of the 206 Clinical Commissioning Groups (CCGs) in England, 51(25%) were involved in the Pioneer programme only, 22(11%) were involved in the Vanguard programme only and 13(6%) were involved in both programmes. We used quasi-experimental methods to compare monthly counts of emergency admissions between four groups of CCGs, before and after the introduction of the two programmes. CCGs involved in the programmes had higher monthly hospital emergency admission rates than non-participants prior to their introduction [7.9 (95% CI:7.8–8.1) versus 7.5 (CI:7.4–7.6) per 1000 population]. From 2013 to 2018, there was a 12% (95% CI:9.5–13.6%) increase in emergency admissions in CCGs not involved in either programme while emergency admissions in CCGs in the Pioneer and Vanguard programmes increased by 6.4% (95% CI: 3.8–9.0%) and 8.8% (95% CI:4.5–13.1%), respectively. CCGs involved in both initiatives experienced a smaller increase of 3.5% (95% CI:-0.3–7.2%). The slowdown largely occurred in the final year of both programmes. Health and social care integration programmes can mitigate but not prevent rises in emergency admissions over the longer-term. Greater financial and expert support from national agencies and involvement in multiple integration initiatives can have cumulative effects.
机译：政策制定者预计卫生和社会护理的整合将改善用户和照顾者体验并减少可避免的医院使用。我们评估英格兰两大全国发起服务一体化方案对急诊医院招生的影响：先锋（2013年11月至2018年3月）和Vanguard（2015年1月至2018年3月）方案。后者对中央机构的财务和专家支持较大。在英格兰的206个临床调试团体（CCG）的中，51（25％）仅参与了先锋计划，22（11％）涉及先锋计划，只有13名（6％）涉及两个方案。我们使用了准实验方法来比较四组CCG之间的每月应急录取，在引入两个方案之前和之后。在介绍之前，涉及该计划的CCG人员的每月医院应急入学率高于非参与者[7.9（95％CI：7.8-8.1），每1000人的7.5（CI：7.4-7.6）]。从2013年到2018年，CCG的紧急入学时间增加了12％（95％CI：9.5-13.6％，而Pioneer和先锋计划中CCG的紧急录取增加6.4％（95％CI ：3.8-9.0％）分别为8.8％（95％CI：4.5-13.1％）。涉及两个举措的CCG较小的增加3.5％（95％CI：-0.3-7.2％）。减速在两个方案的最后一年都很大程度上发生。健康和社会护理一体化计划可以减轻但不会在长期内阻止应急招生升高。来自国家机构的更多财务和专家支持，以及多元融合举措​​的参与可以具有累积效应。

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