Patient outcomes using revised guidance NHS Continuing Care Eligibility Criteria, Scotland (CEL 2008)

Area of Science:

• Gerontology
• Health Services Research
• Public Health Policy

Background:

• The assessment of eligibility for NHS continuing care is crucial for managing patients with complex health needs.
• Revised guidance, CEL (2008), was implemented in Scotland to improve patient selection for continuing care.
• Understanding the efficacy of these revised criteria is essential for optimizing patient outcomes and resource allocation.

Purpose of the Study:

• To evaluate the effectiveness of the revised eligibility criteria for NHS continuing care in Scotland (CEL, 2008).
• To assess patient outcomes, including mortality and re-admission rates, based on the revised assessment categories.

Main Methods:

• A census of 632 patients across 10 hospital sites in NHS Lanarkshire was conducted in September 2009.
• Patients were categorized based on revised CEL (2008) criteria: eligible for NHS continuing care, likely care home, likely home discharge with complex care, or uncertain outcome.
• Frailty was assessed using Rockwood's frailty index in a subgroup, and outcomes were tracked for 1 year.

Main Results:

• 211 patients met the criteria for categorization.
• One-year mortality rates varied significantly: 89% for NHS continuing care, 48% for care home, 35% for home discharge, and 54% for uncertain outcomes.
• Mean frailty scores were highest in the NHS continuing care group (p=0.0002), and re-admission rates were high (60% once, 40% twice or more) for patients discharged home.

Conclusions:

• The CEL (2008) guidance is useful for identifying frail patients with complex needs and limited survival.
• Despite the guidance's utility, high hospital re-admission and mortality rates are observed across all patient groups considered for NHS continuing care.