On the effectiveness of care co-ordination services aimed at preventing hospital admissions and emergency attendances.

Finding alternatives to hospital admissions for older people and helping them to live for as long as possible in their own homes is a key objective of UK health and social policy. However, there is a lack of proof as to whether such alternatives actually work and are cost-effective. The research reported in this paper is based on an evaluation of a care co-ordination service with the aim helping people to remain at home and preventing unnecessary hospital admissions and A&E attendances. An initial evaluation found that the effectiveness of the service was at best marginal. The new method of evaluation described in this paper tracks patient attendance at A&E departments and hospital stays 12 months before they are accepted into the care co-ordination service and evaluates the resultant savings in health care activity. It finds that the service results in between 14 and 29 saved hospital bed days per client per year and between three and eight A&E attendances. Whilst the service does not arrest functional decline in individuals, the incidence of falls is significantly reduced, and that the effect on quality of life is neutral to broadly favourable. It finds that mortality levels are higher than in the general population of similar age but this is probably due to selection effects because clients are unhealthier from the outset, and that in the 90+ age group there is no significant difference. Without the benefit of a control group it is not possible to confirm the results with certainty, but corroborating independent evidence is provided that supports the conclusions reached.