A description of an intermediate care service using routinely collected data

Background Intermediate care is a potentially important means of reducing pressures on acute hospitals. However, intermediate care itself is a heterogeneous concept, so to make appropriate comparisons it is important to be able to describe and to group different types of intermediate care services. The aim of this study was to explore the information available from routine data sources to assess its potential for monitoring performance. Methods A retrospective examination of routine community-based data for a newly established intermediate care nursing service over a 12-month period from April 1998 to March 1999. Results The service provided out-of-hours community nursing care for 903 patients in 1071 episodes of care and 6033 recorded contacts. Although information about patient characteristics and episode start-dates were complete, over half the episode end-dates were missing. The data suggested that this was primarily a domiciliary service for people aged 65 years and over, covering six main care programmes: genito-urinary, neoplasm, wound management, elderly care, gastro-intestinal and locomotor care. Most of the referrals were from primary care clinicians. Conclusion Using routine data can provide a reasonably good description of services, enabling appropriate comparisons of similar services. At present, the way we view and count activity can fragment services and increase the stress on clinicians. We need to shift our service-focused approach to a patient-centred one. This can be done now by consistent use of patient identifiers and by encouraging services to plan data linkage. But a gap still remains with regards to outcomes, limiting our ability to measure effectiveness.