Hospital coordination and integration with social care in England: The effect on post-operative length of stay

•This paper presents a queuing model applied to the hospital discharge process.•Hip replacement discharge co-ordination across hospitals and social care providers is examined empirically.•Post-operative hospital stay is higher the greater the number of social care organisations engaged with.•Post-op...

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Bibliographic Details
Published in:Journal of health economics 2018-09, Vol.61, p.233-243
Main Authors: Fernandez, Jose-Luis, McGuire, Alistair, Raikou, Maria
Format: Article
Language:English
Subjects:
Biomedical materials
Care plans
Commissioning
Coordination
Delayed discharge
Discharge
Health administration
Health care
Health economics
Hip
Hospitalization
Information systems
Integrated care
Integration
Length of stay
Local authorities
Markov chains
Older people
Patients
Queues
Social care
Social services
Surgical implants
Survival
Survival analysis
Variability
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Summary:•This paper presents a queuing model applied to the hospital discharge process.•Hip replacement discharge co-ordination across hospitals and social care providers is examined empirically.•Post-operative hospital stay is higher the greater the number of social care organisations engaged with.•Post-operative stay is higher the greater the volatility in the number of social care organisations engaged with. In spite of significant policy interest in improving the integration of health and social care services, little is known about the economics of coordination across the two sectors. We specify a Markov queuing model and use data collected from administrative records to estimate the link between two proxy indicators of across-sector complexity of discharge arrangements and post-operative length of stay in hospital for older people undergoing hip replacements. The results suggest that the number of local authorities involved in care planning and commissioning of social care services for discharges from a given hospital is significantly positively correlated with longer post-operative lengths of stay. A particularly strong effect is found between variability through time in the number of authorities involved in discharges from a given hospital and lengths of stay. The results suggest that improving information systems and joint assessment processes used during the discharge of patients with social care needs is likely to achieve significant efficiency gains in the health care system as a whole.
ISSN:0167-6296
1879-1646
DOI:10.1016/j.jhealeco.2018.02.005