The government should resist further rolling out of the US Evercare model for reducing emergency hospital admissions among older people without a robust evaluation to determine its cost effectiveness, The King's Fund said today.
The warning follows an independent evaluation of Evercare's 10 English pilot projects, published today by Manchester University. The study revealed that while Evercare resulted in a 50 per cent reduction in emergency hospital admissions of frail elderly patients in the US, it has been less successful in England, with an estimated one per cent reduction in hospital admissions. However, researchers found that the programme is popular among patients and clinical staff.
The King's Fund director of health policy Jennifer Dixon said:
'This is not the green light that ministers were hoping for. Case management programmes like Evercare have the potential to improve the quality of life for these patients. But the results show that before this approach is implemented any further in England, or procured by the NHS from the private sector, a system of robust evaluation should be set up by the Department of Health to examine the cost-effectiveness of different approaches.
'The reasons why Evercare appears to have a modest impact on admissions could be because the method of selecting patients for case management may not accurately identify those at highest risk, or because the type of case management used is not effective. We should learn from these pilots, and try different forms in future. These interim results for Evercare show there is still a lot to learn and evidence about which type of programme is the most effective is still limited.'
Notes to editors:
1. For further information or interviews, please contact Daniel Reynolds at The King's Fund media and public relations office on 020 7307 2632 or 07774 218439 or Michael Moruzzi on 020 7307 2585.
2. The National Primary Care Research and Development Centre, based at Manchester University, published its evaluation of the American Evercare project, currently being piloted in 10 primary care trusts in England, today. The full interim report can be downloaded at www.npcrdc.man.ac.uk.
3. Case management involves providing tailored-care to people identified as being most at risk of hospital admission and is seen as a key weapon in the battle to reduce emergency hospital bed days by five per cent between 2003/4 to 2008.
4. In November the King's Fund published Case-Managing Long-Term Conditions: What impact does it have on the treatment of older people, by Ruth Hutt, Rebecca Rosen and Janet McCauley.
5. The King's Fund is an independent charitable foundation working for better health, especially in London. We carry out research, policy analysis and development activities, working on our own, in partnerships, and through grants. We are a major resource to people working in health, offering leadership and education courses; seminars and workshops; publications; information and library services; and conference and meeting facilities.