A rapid review of what innovative workforce models have helped to rapidly grow capacity for community care to help older adults leave hospital

Older adults who have undergone treatment as hospital inpatients and are now medically fit for discharge back into the community may require additional care to support that transition. Prolonged hospital admissions can also have risks including functional decline, dependency and the risk of hospital acquired infections. The aim of this rapid review was to review the research evidence for the effectiveness of workforce models in the community that may be able to rapidly grow capacity for community care and help older adults leave hospital. 19 studies were included: 11 systematic reviews and 8 UK primary studies not included in the reviews (4 quantitative study designs, 1 case study,1 mixed method study and 2 qualitative studies). The 19 studies evaluated 5 different intervention areas and a range of outcomes including: hospital length of stay; bed day rates, days to early supported discharge, delayed transfers of care (DTOCs); episode length of care; mortality; readmission; and carer, patient or staff perceptions. Intervention areas that were studied the most were: Early Supported Discharge and Transitional care/Continuity of Care. Nine recent UK studies from the systematic reviews describing these interventions were analysed separately for data on outcomes and workforce components. It is difficult to draw firm conclusions due to the limited evidence from a UK setting, and low quality of included studies. There is insufficient information to propose an optimum service design, but the evidence does suggest that interventions that are more comprehensive (covering a range of different components) and more intensive are more likely to be effective. Further research is needed to evaluate the effectiveness of workforce models introduced to rapidly grow capacity for community care to help older adults leave hospital in the UK setting. The Early Supported Discharge and Transitional Care models hold some promise. O_TEXTBOXWales COVID-19 Evidence Centre (WCEC) Rapid ReviewO_ST_ABSReport number -- RR00039 (July 2022)C_ST_ABSRapid Review DetailsReview conducted by: Specialist Unit for Review Evidence (SURE), Cardiff University Review Team: Helen Morgan, Alison Weightman, Kate Lifford, Lydia Searchfield, Mala Mann, Freya Davies Review submitted to the WCEC on: 15th June 2022 Stakeholder consultation meeting: 21st June 2022 Rapid Review report issued by the WCEC on: July 2022 WCEC Team: Alison Cooper, Ruth Lewis, Adrian Edwards, Micaela Gal, Jane Greenwell This review should be cited as: RR00039. Wales COVID-19 Evidence Centre. A rapid review of what innovative workforce models have helped to rapidly grow capacity for community care to help older adults leave hospital. July 2022 DisclaimerThe views expressed in this publication are those of the authors, not necessarily Health and Care Research Wales. The WCEC and authors of this work declare that they have no conflict of interest. TOPLINE SUMMARYO_ST_ABSWhat is a Rapid Review?C_ST_ABSOur rapid reviews use a variation of the systematic review approach, abbreviating or omitting some components to generate the evidence to inform stakeholders promptly whilst maintaining attention to bias. They follow the methodological recommendations and minimum standards for conducting and reporting rapid reviews, including a structured protocol, systematic search, screening, data extraction, quality appraisal, and evidence synthesis to answer a specific question and identify key research gaps. This Rapid Review was undertaken in four weeks to inform an urgent policy priority. Existing systematic reviews and UK primary studies were prioritised. Who is this summary for?The review was requested urgently from Social Care Wales and Health Education and Improvement Wales to help inform the potential workforce planning and service responses across social care and health services to create additional community care capacity to support individuals to live at home, and support timely discharge from hospital. Background / Aim of Rapid ReviewOlder adults who have undergone treatment as hospital inpatients and are now medically fit for discharge back into the community may require additional care to support that transition. Prolonged hospital admissions can also have risks including functional decline, dependency and the risk of hospital acquired infections. The aim of this review was to review the research evidence for the effectiveness of workforce models in the community that may be able to rapidly grow capacity for community care and help older adults leave hospital. Key Findings19 studies were included: 11 systematic reviews and 8 UK primary studies not included in the reviews (4 quantitative study designs, 1 case study,1 mixed method study and 2 qualitative studies). Extent of the evidence baseO_LIThe 19 studies evaluated 5 different intervention areas and a range of outcomes including: hospital length of stay; bed day rates, days to early supported discharge, delayed transfers of care (DTOCs); episode length of care; mortality; readmission; and carer, patient or staff perceptions. C_LIO_LIIntervention areas that were studied the most were: Early Supported Discharge and Transitional care/Continuity of Care. Nine recent UK studies from the systematic reviews describing these interventions were analysed separately for data on outcomes and workforce components. C_LI Recency of the evidence baseO_LIArticles were published 2016-2022 C_LIO_LIThe UK studies extracted from the systematic reviews were published from 2000-2017. C_LI Evidence of effectivenessO_LIThe body of systematic review evidence for Early Supported Discharge is consistent and indicates that early supported discharge reduces length of hospital stay although the recent UK studies did not show a consistent pattern. C_LIO_LIThe body of systematic review evidence for Transitional care/Continuity of care is fairly consistent and tended to demonstrate a reduction in readmissions although the recent UK studies did not show a consistent pattern. C_LIO_LIAll the interventions evaluated were multi-disciplinary. C_LIO_LIGeographical location adds to the heterogeneity in intervention designs and outcomes. C_LIO_LIStaff perceptions, reported by Baxter et al. (2020), informing how safe transitions can be facilitated include: getting to know the patient; building relationships within and across teams and bridging gaps within the system. C_LI Policy ImplicationsO_LIIt is difficult to draw firm conclusions due to the limited evidence from a UK setting, and low quality of included studies. C_LIO_LIThere is insufficient information to propose an optimum service design but the evidence does suggest that interventions that are more comprehensive (covering a range of different components) and more intensive are more likely to be effective. C_LIO_LIFurther research is needed to evaluate the effectiveness of workforce models introduced to rapidly grow capacity for community care to help older adults leave hospital in the UK setting. C_LIO_LIThe Early Supported Discharge and Transitional Care models hold some promise. C_LI Strength of EvidenceO_LINone of the systematic reviews was rated as high quality. C_LIO_LIOf the 8 primary studies identified that were not included in the systematic reviews, 1 primary quantitative study and one primary qualitative study were rated as high quality. C_LIO_LIThe 9 UK studies identified within the systematic reviews on Early Supported Discharge and Transitional Care/Continuity of Care were not quality appraised. C_LI C_TEXTBOX