Understanding Pathways into Care homes using Data (UnPiCD study): a retrospective cohort study using national linked health and social care data
ENRICHEnabling Research in Care Homes
POSTS
Understanding Pathways into Care homes using Data (UnPiCD study): a retrospective cohort study using national linked health and social care data
A new publication exploring pathways into care homes
Key Points
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Pathways into care home are a topic of public, professional and policy interest.
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Individuals moving-in to care homes from hospital are clinically distinct from those moving-in from the community.
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Differences include greater dependency, frailty and recent health events including fracture, stroke, and significant mental illness.
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National cross-sectoral data linkage between social care and health data is feasible as a research methodology.
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However, linked data are biased towards health measures with limited information on care needs, complexity and social networks.
Abstract
Background
Pathways into care are poorly understood but important life events for individuals and their families. UK policy is to avoid moving-in to care homes from acute hospital settings. This assumes that moves from secondary care represent a system failure. However, those moving to care homes from community and hospital settings may be fundamentally different groups, each requiring differing care approaches.
Objective
To characterise individuals who move-in to a care home from hospital and compare with those moving-in from the community.
Design and setting
A retrospective cohort study using cross-sectoral data linkage of care home data.
Methods
We included adults moving-in to care homes between 1/4/13 and 31/3/16, recorded in the Scottish Care Home Census. Care home data were linked to general and psychiatric hospital admissions, community prescribing and mortality records to ascertain comorbidities, significant diagnoses, hospital resource use, polypharmacy and frailty. Multivariate logistic regression identified predictors of moving-in from hospital compared to from community.
Results
We included 23,892 individuals moving-in to a care home, 13,564 (56.8%) from hospital and 10,328 (43.2%) from the community. High frailty risk adjusted Odds Ratio (aOR) 5.11 (95% Confidence Interval (CI): 4.60–5.68), hospital discharge with diagnosis of fracture aOR 3.91 (95%CI: 3.41–4.47) or stroke aOR 8.42 (95%CI: 6.90–10.29) were associated with moving-in from hospital. Discharge from in-patient psychiatry was also a highly significant predictor aOR 19.12 (95%CI: 16.26–22.48).
Conclusions
Individuals moving-in to care homes directly from hospital are clinically distinct from those from the community. Linkage of cross-sectoral data can allow exploration of pathways into care at scale.
Authors:
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