Journal of public health medicine
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J Public Health Med · Jun 1994
Clinical Trial Controlled Clinical TrialEvaluation of a Hospital at Home scheme for the early discharge of patients with fractured neck of femur.
The community health services in Southern Derbyshire, in conjunction with an acute hospital, established a pilot scheme for the early discharge of fractured neck of femur patients from hospital to their own homes. The scheme was evaluated by prospectively comparing a group of patients using Hospital at Home (HAH) and a group receiving hospital care only. The main outcomes measured were the proportion of hospital admissions for fractured neck of femur using HAH, length of stay, patient satisfaction, general health status at discharge as measured by the Nottingham Health Profile, and three-month mortality and readmission rates. ⋯ In the first year of the scheme, 76 (18 per cent) of the 432 hospital admissions for fractured neck of femur fitted the selection criteria and agreed to admission to HAH. Thirty-four patients were identified who were suitable for HAH but not admitted to it. The comparison of the 76 HAH patients and 34 hospital patients revealed that HAH patients were discharged from hospital an average of 7 days earlier; patients in both groups were satisfied with the care they received; the general health status of the two groups at discharge was similar, with the exception that HAH patients had better emotional health on discharge from care; the three-month mortality rate was similar in both groups (5 per cent); the readmission rate for HAH patients appeared higher than for hospital patients but this difference was not statistically significant (15.8 per cent versus 8.8 per cent, Fisher's exact test, p = 0.187).(ABSTRACT TRUNCATED AT 250 WORDS)
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J Public Health Med · Jun 1994
Attendance at accident and emergency departments: unnecessary or inappropriate?
The proportion of attenders at accident and emergency (A&E) departments who present 'inappropriately' with conditions which could be managed in general practice has been estimated at between 6.7 per cent and 64-89 per cent. These estimates have been based on subjective assessments by clinicians, or on an objective classification developed by the Nuffield Provincial Hospitals Trust (NPHT). This study sought to validate this classification, and to develop and validate other objective systems of classifying A&E attenders. ⋯ This method was applied retrospectively to random samples of 8877 adult self-referrals to 16 English A&E departments, and yielded an estimate that 23 per cent could have been treated in general practice. This approach provides a simple and valid retrospective method for identifying patients who were suitable for care in general practice. The method may be used to identify groups of patients who frequently attend inappropriately, to identify areas in which primary care needs are not being effectively met in general practice, and to form a basis for planning and auditing strategies to meet those needs in a more appropriate setting.