4. Health Services Research and Intermediate Care

Lead academic:
Professor Stuart Parker, SA Core Academic Group, tel: +44 (0) 114 271 5891

Intermediate care is at the centre of the national agenda for the development and modernisation of NHS services for older people. SISA core staff (Prof. S G Parker, Prof. J Young) and Advisory Group (Prof. P M Enderby) are developing a programme of research which addresses key issues in the field. Our activities include: literature reviews; the development and maintenance of a national network of researchers and practitioners; a programme of evaluative research, and, dissemination and education through conferences and workshops.

Literature Reviews

In Progress:

Models of Delivery of Health Care to Older People in Long-term Care: A Systematic Review. NHS Executive Trent Policy and Practice. Nuffield Community Care Studies Unit (Leicester), in collaboration with the Departments of General Practice and Psychiatry for the Elderly, University of Leicester and the Sheffield Institute for Studies on Ageing.

Completed:

Systematic review and meta-analysis of day hospital care for older people (Cochrane Review). Professor J Young (Bradford). A Forster, J Young, P Langhorne. BMJ 1999; 318: 837-841.
A systematic review of discharge arrangements for older people NHS R&D/ NHS Health Technology Assessment Programme. Professor S G Parker, S M Peet, A McPherson, A M Cannaby, R Baker, A Wilson, J Lindesay, G Parker, K Abrams, D R Jones. Health Technology Assessment 2002, in press.
The best place of care for older people after acute and during sub-acute illness. Systematic review. NHS Executive West Midlands. G Parker, P Bhakta, S Katbamna, C Lovett, S Paisley, S Parker, K Phelps, R Baker, C Jagger, C J Lindesay, B Shepperdson, A Wilson. Journal of Health Services Research and Policy 2000; 5(3): 176-189.

Development of a National Network of Researchers and Practitioners

This is being achieved through the Trent Institute for Health Services Research, the British Geriatrics Society Special Interest Group on Health Services Research, and in collaboration with the Royal College of Physicians Clinical Effectiveness Unit.

The Trent Institute for Health Services Research. Health and Social Care of Older People
The three units of the Trent Institute (Sheffield, Nottingham and Leicester) and their Universities have complementary research strengths in the areas of health and social care for older people.

Sheffield Institute for Studies on Ageing has strengths in geriatric assessment, intermediate care and rehabilitation, osteoporosis, design in caring environments and population perspectives in health and well-being of older people worldwide.

Nottingham has an Ageing and Disability Research Unit (ADRU) with major current areas of research activity including community rehabilitation (Intermediate Care), stroke rehabilitation, transport and metabolic bone disease.

In Leicester, the Department of Epidemiology and Public Health hosts groups involved in cohort trends in health and development and dissemination of health indicators such as disability-free life expectancy, the development of screening instruments and interventions to improve the health of older people within primary care, models for forecasting population health needs (including the need for long-term care and prevalence of dementia) and intermediate and long-term care. In addition, the Leicester unit of the Trent Institute is also the lead for the Trent Public Health Observatory work on the health of older people.

The British Geriatrics Society Health and Services Research Group
Through the work of this group we bring together diverse methodological and theoretical expertise in research for older people and carers. The aims of the group include:

To become widely recognised and readily available as an expert resource in the field of Health Services.
Research for older people. To influence research policy, research funding and the national research agenda in Health Services Research for older people.
To exploit links with established groups such as the Society of Research into Rehabilitation and British Society of Rehabilitation Medicine.
A randomised controlled trial to investigate the impact of different intensities of community rehabilitation (NHS Trent)
The development of a taxonomy of processes of rehabilitation (NHS Trent).

Programme of Evaluations

With colleagues in Leicester (Nuffield Community Care Studies Unit), Newcastle (Centre for Health Services Research) and Leeds (Nuffield Institute for Health), the SISA team have been commissioned by the NHS R&D programme to carry out controlled trials in key areas of intermediate care: rehabilitation, community care and admission avoidance.

Post-acute care trial of community hospitals (PATCH) Department of Health Policy Research Programme & Medical Research Council. In collaboration between the Universities of Bradford and York and clinical collaborators.
A national evaluation of the costs and outcomes of Intermediate Care Services for older people. DoH Policy Research Programme & Medical Research Council. Nuffield Community Care Studies Unit (University of Leicester) and Health Services Management Centre (University of Birmingham), in collaboration with the Department of Health Sciences (Leicester) and the Sheffield Institute for Studies on Ageing.
Best Place of Care for Older People after Acute and during Sub-acute Illness. Second Stage. NHS Executive West Midlands. Nuffield Community Care Studies Unit (Leicester), in collaboration with the Departments of General Practice and Psychiatry for the Elderly, University of Leicester and the Sheffield Institute for Studies on Ageing.
A randomised controlled trial of Day Hospital Rehabilitation compared with Rehabilitation at Home. NHS Executive (Health Technology Assessment). Sheffield Institute for Studies on Ageing in collaboration with the Centre for Health Services Research, University of Newcastle Upon Tyne, ScHARR (Health Economics), Nuffield Community Care Studies Unit and the Departments of General Practice and Psychiatry for the Elderly, University of Leicester.
Evaluation by randomised trial of community hospital care. PPP Healthcare Medical Trust. Professor John Young (Bradford).
Prospective evaluation of intermediate care services for older people in Leeds. Leeds Health Authority. Professor John Young (Bradford).
Controlled trial to evaluate the Oswestry standing frame to hasten early stroke recovery. NHS Northern & Yorkshire R&D. Professor John Young (Bradford).
A randomised controlled trial to evaluate improved communication to patients and carers recovering from acute stroke. NHS Northern & Yorkshire R&D. Professor John Young (Bradford).

Conferences

The British Geriatrics Society Special Interest Group on Health Services Research has hosted a successful series of conferences and workshops on Health Services Research for Older People at national and regional levels including:

Trent Regional Conference on Health Services Research for Older People (October 1999)
Joint AgeNet / British Geriatrics Society Workshop on Service Evaluation Methodologies (March 2000) JRF Gladman. Methods to evaluate services. Age and Ageing 2000; 29, 29-S2:3.
Joint Conference on Intermediate Care with Royal College of Physicians (November 2000). I Carpenter, JRF Gladman, SG Parker, J Potter. Intermediate Care. Definitions, clinical perspectives, the evidence base and research methodologies. Age and Ageing. In press.

Other relevant conferences include:

Royal College of Physicians (July 2003). Community Care of Older People: policies, problems and practice.
Capita Learning and Development (July 2003). Managing delayed discharges and developing intermediate care services.