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Effectiveness of nursing-led inpatient care for patients with post-acute health care needs:secondary data analysis from a programme of randomized controlled trials

Harris, Ruth, Wilson-Barnett, Jenifer and Griffiths, Peter (2007) Effectiveness of nursing-led inpatient care for patients with post-acute health care needs:secondary data analysis from a programme of randomized controlled trials Journal of Evaluation in Clinical Practice, 13, (2), pp. 198-205. (doi:10.1111/j.1365-2753.2006.00672.x).

Record type: Article

Abstract

Objectives: To determine whether transfer to a nursing-led inpatient unit (NLIU) prior to discharge from hospital can improve clinical outcome and reduce length of stay and readmission rate for medically stable post-acute patients assessed as requiring inpatient care.

Method: Retrospective secondary data analysis of individual patient data (n = 471) from a programme of three, purposefully replicated, pragmatic randomized controlled trials. Patients were referred to the NLIU by their consultant (attending doctor/surgeon) for nursing-led subacute/post-acute care and randomly allocated to a treatment group for planned transfer to the NLIU for the remainder of their hospital stay or to a control group for traditional consultant-led care in acute wards. Outcome measures were physical function (Barthel Index), length of stay, discharge destination, mortality, psychological well-being (General Health Questionnaire-12), health-related distress (Nottingham Health Profile Distress Index), incidence of complications and readmission within 7, 28, 90 and 180 days.

Results: Patients allocated to the NLIU showed greater improvement in physical function (P < 0.001) and were more likely to be discharged to live independently in the community than controls [odds ratio (OR) = 0.42, P = 0.001] although they spent longer in hospital (P = 0.003). They showed greater improvement in psychological well-being (P = 0.001) and health-related distress (P = 0.025) and a lower incidence of pressure ulcers (OR = 0.33, P = 0.011).

Conclusion: Transfer to a NLIU can have a beneficial effect on outcomes of care for post-acute patients with complex health and social needs although length of stay is longer. This study strengthens the evidence of effectiveness of the NLIU model of care and provides evidence of effectiveness of post-acute and subacute models of care.

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More information

Published date: April 2007
Keywords: individual patient data, nursing-led care, post-acute care, randomized controlled trial, secondary data analysis

Identifiers

Local EPrints ID: 168229
URI: http://eprints.soton.ac.uk/id/eprint/168229
ISSN: 1356-1294
PURE UUID: ea822837-4f81-48c0-a0dd-2531ed316305
ORCID for Peter Griffiths: ORCID iD orcid.org/0000-0003-2439-2857

Catalogue record

Date deposited: 25 Nov 2010 14:20
Last modified: 18 Jul 2017 12:23

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Contributors

Author: Ruth Harris
Author: Jenifer Wilson-Barnett
Author: Peter Griffiths ORCID iD

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