There is a warning today that Government plans to use community matrons as a way to keep older people out of hospital may be based on misleading data. The warning, published in the British Medical Journal, is based on a study by the National Primary Care Research and Development Centre at the University of Manchester.The Government plans are designed to cut hospital stays by tracking admission rates in older patients and then using specially trained nurses to care for the elderly people at home. But Research and Development Centre Director Martin Roland, and colleagues, felt the approach could be seriously misleading because admissions would probably decline anyway even without intervention. They tested this theory by tracking emergency admissions of patients who were aged 65 or older and who had had at least two emergency visits to hospital in a single year. That is one of the criteria being used to identify patients for enrolment in the NHS community matron scheme as well as being the main criterion for admission to the Evercare programme, which the research team is also evaluating.
This ‘high risk’ group was monitored over a five-year period from 1997-98 and compared to the general population of the same age. The research found there was a sharp fall in total admissions and bed days over the period. The ‘high risk’ 65 to 74 year old age group had an admission rate 20 times greater than the general population of the same age in the first year of the study but this ratio fell to 5.2 the next year and by 2002-3 it was 1.7.The study shows that the entire group – comprising 2.9 per cent of the total population of England aged over 65 in mid 1997 – accounted for 38 per cent of emergency admissions in the first year but only 3.2 per cent in 2002-3.
The authors say there needs to be further research to refine the definition of ‘high risk’ groups for interventions to reduce admissions. They warn that the effectiveness of admission avoidance schemes cannot be judged by tracking admission rates without careful comparison with a control group.
In an editorial accompanying the research paper in the BMJ, Jill Morrison, Professor of General Practice at Glasgow University, says evaluating case management by community matrons will require methods and outcome measures to be chosen with care to test the initiative’s true effect on emergency admissions.
She believes the wider impact of the plan to transfer 3,000 experienced district nurses or other health professionals from their current jobs to take on the new role should also be considered as it may leave gaps in the delivery of other community based services.