A rapid review of what innovative workforce models have helped to rapidly grow capacity for community care to help older adults leave hospital

Abstract: Older adults who have undergone treatment as hospital inpatients and are now medically fit for discharge back into the community may require additional care to support that transition. Prolonged hospital admissions can also have risks including functional decline, dependency and the risk of hospital acquired infections. The aim of this rapid review was to review the research evidence for the effectiveness of workforce models in the community that may be able to rapidly grow capacity for community care and help older adults leave hospital. 19 studies were included: 11 systematic reviews and 8 UK primary studies not included in the reviews (4 quantitative study designs, 1 case study,1 mixed method study and 2 qualitative studies). The 19 studies evaluated 5 different intervention areas and a range of outcomes including: hospital length of stay; bed day rates, days to early supported discharge, delayed transfers of care (DTOCs); episode length of care; mortality; readmission; and carer, patient or staff perceptions. Intervention areas that were studied the most were: Early Supported Discharge and Transitional care/Continuity of Care. Nine recent UK studies from the systematic reviews describing these interventions were analysed separately for data on outcomes and workforce components. It is difficult to draw firm conclusions due to the limited evidence from a UK setting, and low quality of included studies. There is insufficient information to propose an optimum service design, but the evidence does suggest that interventions that are more comprehensive (covering a range of different components) and more intensive are more likely to be effective. Further research is needed to evaluate the effectiveness of workforce models introduced to rapidly grow capacity for community care to help older adults leave hospital in the UK setting. The Early Supported Discharge and Transitional Care models hold some promise.