Understanding Pathways into Care-homes using Data (UnPiCD study): a two-part model to estimate inpatient and care-home costs using national linked health and social care data

Ciminata, G., Burton, J.K. , Quinn, T.J. and Geue, C. (2024) Understanding Pathways into Care-homes using Data (UnPiCD study): a two-part model to estimate inpatient and care-home costs using national linked health and social care data. BMC Health Services Research, 24, 281. (doi: 10.1186/s12913-024-10675-z) (PMID:38443919) (PMCID:PMC10916167)

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Background: Pathways into care-homes have been under-researched. Individuals who move-in to a care-home from hospital are clinically distinct from those moving-in from the community. However, it remains unclear whether the source of care-home admission has any implications in term of costs. Our aim was to quantify hospital and care-home costs for individuals newly moving-in to care homes to compare those moving-in from hospital to those moving-in from the community. Methods: Using routinely-collected national social care and health data we constructed a cohort including people moving into care-homes from hospital and community settings between 01/04/2013-31/03/2015 based on records from the Scottish Care-Home Census (SCHC). Individual-level data were obtained from Scottish Morbidity Records (SMR01/04/50) and death records from National Records of Scotland (NRS). Unit costs were identified from NHS Scotland costs data and care-home costs from the SCHC. We used a two-part model to estimate costs conditional on having incurred positive costs. Additional analyses estimated differences in costs for the one-year period preceding and following care-home admission. Results: We included 14,877 individuals moving-in to a care-home, 8,472 (57%) from hospital, and 6,405 (43%) from the community. Individuals moving-in to care-homes from the community incurred higher costs at £27,117 (95% CI £ 26,641 to £ 27,594) than those moving-in from hospital with £24,426 (95% CI £ 24,037 to £ 24,814). Hospital costs incurred during the year preceding care-home admission were substantially higher (£8,323 (95% CI£8,168 to £8,477) compared to those incurred after moving-in to care-home (£1,670 (95% CI£1,591 to £1,750). Conclusion: Individuals moving-in from hospital and community have different needs, and this is reflected in the difference in costs incurred. The reduction in hospital costs in the year after moving-in to a care-home indicates the positive contribution of care-home residency in supporting those with complex needs. These data provide an important contribution to inform capacity planning on care provision for adults with complex needs and the costs of care provision.

Item Type:Articles
Additional Information:This work was supported by the Dunhill Medical Trust [grant number RPGF2002\197] and the Scottish Informatics and Linkage Collaboration. JKB is supported by an NHS Education for Scotland/Chief Scientists Office Postdoctoral Clinical Lectureship (PCL/21/01).
Keywords:Care-home, hospital, routine data, data linkage, social care, older people costing-analysis, two-part model.
Glasgow Author(s) Enlighten ID:Quinn, Professor Terry and Ciminata, Dr Giorgio and Geue, Dr Claudia and Burton, Dr Jenni
Authors: Ciminata, G., Burton, J.K., Quinn, T.J., and Geue, C.
College/School:College of Medical Veterinary and Life Sciences > School of Cardiovascular & Metabolic Health
College of Medical Veterinary and Life Sciences > School of Health & Wellbeing > Health Economics and Health Technology Assessment
Journal Name:BMC Health Services Research
Publisher:BioMed Central
ISSN (Online):1472-6963
Copyright Holders:Copyright © 2024 The Author(s)
First Published:First published in BMC Health Services Research 24:281
Publisher Policy:Reproduced under a Creative Commons license

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Project CodeAward NoProject NamePrincipal InvestigatorFunder's NameFunder RefLead Dept
308655New care home admission after hospitalisation - understanding trajectories and predictors using linked health and social care dataJennifer BurtonDunhill Medical Trust (DUNHILLM)RPGF2002\197SCMH - Cardiovascular & Metabolic Health
315914Using and improving Scotland's care home data: a mixed methods programme of data linkage research and consensus gatheringJennifer BurtonOffice of the Chief Scientific Adviser (CSO)PCL/21/01SCMH - Cardiovascular & Metabolic Health