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The relationship between staff skill mix, costs and outcomes in intermediate care services

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      Abstract

      BackgroundThe purpose of this study was to assess the relationship between skill mix, patient outcomes, length of stay and service costs in older peoples' intermediate care services in England.MethodsWe undertook multivariate analysis of data collected as part of the National Evaluation of Intermediate Care Services. Data were analysed on between 337 and 403 older people admitted to 14 different intermediate care teams. Independent variables were the numbers of different types of staff within a team and the ratio of support staff to professionally qualified staff within teams. Outcome measures include the Barthel index, EQ-5D, length of service provision and costs of care.ResultsIncreased skill mix (raising the number of different types of staff by one) is associated with a 17% reduction in service costs (p = 0.011). There is weak evidence (p = 0.090) that a higher ratio of support staff to qualified staff leads to greater improvements in EQ-5D scores of patients.ConclusionsThis study provides limited evidence on the relationship between multidisciplinary skill mix and outcomes in intermediate care services.

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      Most cited references 19

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      Modeling valuations for EuroQol health states.

       Paul Dolan (1997)
      It has become increasingly common for preference-based measures of health-related quality of life to be used in the evaluation of different health-care interventions. For one such measure, The EuroQol, designed to be used for these purposes, it was necessary to derive a single index value for each of the 243 health states it generates. The problem was that it was virtually impossible to generate direct valuations for all of these states, and thus it was necessary to find a procedure that allows the valuations of all EuroQol states to be interpolated from direct valuations on a subset of these. In a recent study, direct valuations were elicited for 42 EuroQol health states (using the time trade-off method) from a representative sample of the UK population. This article reports on the methodology that was adopted to build up a "tariff" of EuroQol values from this data. A parsimonious model that fits the data well was defined as one in which valuations were explained in terms of the level of severity associated with each dimension, an intercept associated with any move away from full health, and a term that picked up whether any dimension in the state was at its most severe level. The model presented in this article appears to predict the values of the states for which there are direct observations and, thus, can be used to interpolate values for the states for which no direct observations exist.
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        The Barthel ADL Index: a reliability study.

        The Barthel Index is a valid measure of disability. In this study we investigated the reliability of four different methods of obtaining the score in 25 patients: self-report, asking a trained nurse who had worked with the patient for at least one shift, and separate testing by two skilled observers within 72 hours of admission. Analysis of total (summed) scores revealed a close correlation between all four methods: a difference of 4/20 points was likely to reflect a genuine difference. In individual items, most disagreement was minor and involved the definition of middle grades. Asking an informed nurse or relative was as reliable as testing, and is quicker.
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          The impact of 29 chronic conditions on health-related quality of life: a general population survey in Finland using 15D and EQ-5D.

          Health-related quality of life (HRQoL) is an essential outcome of health care, but there is no gold standard of HRQoL measurement. We investigated the impact of major chronic conditions on HRQoL using 15D and EQ-5D in a representative sample of Finns. Information on chronic somatic conditions was obtained by interviews. Psychiatric disorders were diagnosed using a structured interview (M-CIDI). Tobit and CLAD regression analysis was used to estimate the impact of conditions on HRQoL at the individual and population level. Adjusted for other conditions and sociodemographic variables, Parkinson's disease had the largest negative impact on HRQoL at the individual level, followed by anxiety disorders, depressive disorders and arthrosis of the hip and knee. Based on prevalence, arthrosis of the hip or knee, depression, back problems and urinary incontinence caused the greatest loss of HRQoL at the population level. The results obtained with the two HRQoL measures differed markedly for some conditions and the EQ-5D results also varied with the regression method used. Musculoskeletal disorders are associated with largest losses of HRQoL in the Finnish population, followed by psychiatric conditions. Different HRQoL measures may systematically emphasize different conditions.
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            Author and article information

            Affiliations
            [1 ]School of Health and Related Research, University of Sheffield, Regent Court, 30 Regent Street, Sheffield S1 4DA, UK
            [2 ]Health Economics Unit, Health and Population Sciences, University of Birmingham, Edgbaston, Birmingham B15 2TT, UK
            [3 ]Centre for Health and Social Care Research, Sheffield Hallam University, Montgomery House, 32 Collegiate Crescent, Collegiate Campus, Sheffield S10 2BP, UK
            [4 ]Department of Health Sciences, University of Leicester, Adrian Building, University Road, Leicester LE1 7RH, UK
            [5 ]Centre for Clinical Epidemiology and Evaluation, University of British Columbia, Seventh Floor, 828 West 10th Avenue, Research Pavilion, Vancouver BC V5Z 1M9, Canada
            Contributors
            Journal
            BMC Health Serv Res
            BMC Health Services Research
            BioMed Central
            1472-6963
            2010
            29 July 2010
            : 10
            : 221
            2921080
            1472-6963-10-221
            20670428
            10.1186/1472-6963-10-221
            Copyright ©2010 Dixon et al; licensee BioMed Central Ltd.

            This is an Open Access article distributed under the terms of the Creative Commons Attribution License ( http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

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            Research Article

            Health & Social care

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