Measuring and modelling occupancy time in NHS continuing healthcare

Abstract

Background: Due to increasing demand and financial constraints, NHS continuing healthcare systems seek to find better ways of forecasting demand and budgeting for care. This paper investigates two areas of concern, namely, how long existing patients stay in service and the number of patients that are likely to be still in care after a period of time.

Methods: An anonymised dataset containing information for all funded admissions to placement and home care in the NHS continuing healthcare system was provided by 26 (out of 31) London primary care trusts. The data related to 11289 patients staying in placement and home care between 1 April 2005 and 31 May 2008 were first analysed. Using a methodology based on length of stay (LoS) modelling, we captured the distribution of LoS of patients to estimate the probability of a patient staying in care over a period of time. Using the estimated probabilities we forecasted the number of patients that are likely to be still in care after a period of time (e.g. monthly).

Results: We noticed that within the NHS continuing healthcare system there are three main categories of patients. Some patients are discharged after a short stay (few days), some others staying for few months and the third category of patients staying for a long period of time (years). Some variations in proportions of discharge and transition between types of care as well as between care groups (e.g. palliative, functional mental health) were observed. A close agreement of the observed and the expected numbers of patients suggests a good prediction model.

Conclusions: The model was tested for care groups within the NHS continuing healthcare system in London to support Primary Care Trusts in budget planning and improve their responsiveness to meet the increasing demand under limited availability of resources. Its applicability can be extended to other types of care, such as hospital care and re-ablement. Further work will be geared towards updating the dataset and refining the results.

Figure 1

Model for the movements of residents in institutional long-term care adapted from [7]. Upon entering either type of care residents follow a short stay state [or period] after which they are either discharged or enter a long-stay state, which may last for months, if not years. In addition residents in residential care may also transfer to nursing care upon leaving their short or long stay state. All residents are eventually discharged.

Figure 2

Box plots of age per type of care and per care group. Note that as a number of patients have a footstep in both placement and home care, they appear in box plots relative to both types of care.

Figure 3

Percentile distribution of Length-of-Stay per type of care and care group. PDA: Physically Disabled Adult; PF: Physically Frail; OMH: Organic Mental Health; LD: Learning Disability; FMH: Functional Mental Health.

Figure 4

Conceptual model of residents' movement within a type of care in NHS Continuing healthcare. Within the NHS continuing healthcare system there are three main categories of patients. Some patients are discharged after a short stay (few days), some others staying for few months (medium stay) and the third category of patients staying for a long period of time (long stay, e.g. years).

Figure 5

Survival patterns in Placement and Home care at the London-wide level. Figures 5.a and 5.c illustrate the average length of stay (inside ellipses) for three distinctive conceptual states, i.e. short-stay, medium-stay and long-stay states, as well as the proportions of discharge and transition (on the arrows) between states for both types of care. Figures 5.b and 5.d illustrate the survival curves for placement and home care, respectively.

Figure 6

Survival patterns of Physically Frail and Palliative residents in Placement. Figures 6.a and 6.c illustrate the three distinctive conceptual states for both types of care. Figures 6.b and 6.d illustrate the survival curves for placement and home care, respectively.

Figure 7

The observed and the projected monthly number of Physically Frail and Palliative residents in Placement. Dotted lines represent the observed monthly number of patients; Solid lines represent the expected monthly number of patients.