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      Community Hospitals in Selected High Income Countries: A Scoping Review of Approaches and Models

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          Abstract

          Background:

          There is no single definition of a community hospital in the UK, despite its long history. We sought to understand the nature and scope of service provision in community hospitals, within the UK and other high-income countries.

          Methods:

          We undertook a scoping review of literature on community hospitals published from 2005 to 2014. Data were extracted on features of the hospital model and the services provided, with results presented as a narrative synthesis.

          Results:

          75 studies were included from ten countries. Community hospitals provide a wide range of services, with wide diversity of provision appearing to reflect local needs. Community hospitals are staffed by a mixture of general practitioners (GPs), nurses, allied health professionals and healthcare assistants. We found many examples of collaborative working arrangements between community hospitals and other health care organisations, including colocation of services, shared workforce with primary care and close collaboration with acute specialists.

          Conclusions:

          Community hospitals are able to provide a diverse range of services, responding to geographical and health system contexts. Their collaborative nature may be particularly important in the design of future models of care delivery, where emphasis is placed on integration of care with a key focus on patient-centred care.

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          Most cited references60

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          Balancing efficiency of health services and equity of access in remote areas in Greece.

          Data envelopment analysis (DEA) was used to investigate the efficiency of a set of small-scaled Greek hospitals known as hospital-health centers (HHCs). These facilities naturally provide primary and secondary care but are also expected to function as health centers addressing mostly preventive medicine, hygiene and other public health issues. They are located in remote rural areas and serve the relatively small local populations. This study aimed to obtain insight on their productive efficiency in light of their particular role. The sample consisted of 17 from the 18 units existing in the Greek NHS. Variables chosen to characterize production were numbers of doctors, nurses and beds as inputs, and admissions, outpatient visits and preventive medical services as outputs. The DEA model was input oriented, allowed for constant returns to scale and units were ranked according to a benchmarking approach. Analyses were performed with and without the preventive medicine variable and the results demonstrated technical inefficiencies 26.77 and 25.13%, respectively. Location appeared to affect performance, with remote units, e.g. on small islands, more inefficient. This raises the question if correcting reduced efficiency compromises equity of service access for highly dependent populations. Moreover, we observed superior performance of units additionally offering preventive medical services. This generates another question as to the role these facilities should play in our currently changing health care system.
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            Therapy via videoconferencing: a route to client empowerment?

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              Intermediate care at a community hospital as an alternative to prolonged general hospital care for elderly patients: a randomised controlled trial

              Background Demographic changes together with an increasing demand among older people for hospital beds and other health services make allocation of resources to the most efficient care level a vital issue. The aim of this trial was to study the efficacy of intermediate care at a community hospital compared to standard prolonged care at a general hospital. Methods In a randomised controlled trial 142 patients aged 60 or more admitted to a general hospital due to acute illness or exacerbation of a chronic disease 72 (intervention group) were randomised to intermediate care at a community hospital and 70 (general hospital group) to further general hospital care. Results In the intervention group 14 patients (19.4%) were readmitted for the same disease compared to 25 patients (35.7%) in the general hospital group (p = 0.03). After 26 weeks 18 (25.0%) patients in the intervention group were independent of community care compared to seven (10.0%) in the general hospital group (p = 0.02). There were an insignificant reduction in the number of deaths and an insignificant increase in the number of days with inward care in the intervention group. The number of patients admitted to long-term nursing homes from the intervention group was insignificantly higher than from the general hospital group. Conclusion Intermediate care at a community hospital significantly decreased the number of readmissions for the same disease to general hospital, and a significantly higher number of patients were independent of community care after 26 weeks of follow-up, without any increase in mortality and number of days in institutions.
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                Author and article information

                Contributors
                Role: Analyst
                Role: Analyst
                Role: Senior Analyst
                Role: Senior Analyst
                Role: Associate Director
                Role: Senior Research Leader
                Role: Professor of Reproductive Health
                Role: Hub Coordinator
                Journal
                Int J Integr Care
                Int J Integr Care
                1568-4156
                International Journal of Integrated Care
                Ubiquity Press
                1568-4156
                24 November 2016
                Oct-Dec 2016
                : 16
                : 4
                : 13
                Affiliations
                [-1]RAND Europe, Westbrook Centre, Milton Road, Cambridge, CB4 1YG, United Kingdom
                [-2]Bournemouth House B112c, 19 Christchurch Road, Bournemouth, BH1 3LH, United Kingdom
                [-3]London School of Economics and Political Science, Houghton Street, London WC2A 2AE, United Kingdom
                Author information
                http://orcid.org/0000-0003-1933-0168
                Article
                10.5334/ijic.2463
                5354221
                d0a52bf0-0e88-4e0d-b0bf-211ae1a5b8ea
                Copyright: © 2016 The Author(s)

                This is an open-access article distributed under the terms of the Creative Commons Attribution 4.0 International License (CC-BY 4.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. See http://creativecommons.org/licenses/by/4.0/.

                History
                : 01 April 2016
                : 24 October 2016
                Categories
                Research and Theory

                Health & Social care
                cottage hospital,primary care,health systems,service delivery models,integration,primary/secondary care interface,community hospital

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