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Improving Hospital at Home for frail older people: insights from a quality improvement project to achieve change across regional health and social care sectors

Pearson, M.; Hemsley, A.; Blackwell, R.; Pegg, L.; Custerson, L.


A. Hemsley

R. Blackwell

L. Pegg

L. Custerson


© 2017 The Author(s). Background: Against a background of rising numbers of frail older people, there is a need to improve quality and safety of services whilst containing costs. Improving patient outcomes requires change across hospital and community systems. Our objective was to change practice in order to deliver a Hospital at Home programme (admission avoidance and early supported discharge) for frail older people across a regional commissioning area. The programme, undertaken within the Northern, Eastern & Western Devon Clinical Commissioning Group (CCG) sub-localities of Exeter (population 120,000) and Woodbury, Exmouth and Budleigh Salterton (towns with populations of around 10,000), involved reconfiguration of existing services rather than being a stand-alone intervention. Methods: Quality Improvement methodology, with hospital and community staff using Plan-Do-Study-Act (PDSA) cycles to implement and test service changes. Outcome measures: 1) Discharge destination; 2) Length of stay; 3) Acute Community Team referrals. Results: Against a backdrop of intense financial pressures, significant community bed closures, and difficult relations between hospital and community services, outcomes remained stable (discharge destination, length of hospital stay, and number of referrals to the community team). Conclusion: PDSA cycles enabled stakeholders across acute and community services to be involved, promoted a process of collaborative inquiry and ownership of findings, and improved motivation to act on results and produce change. Practitioners and managers seeking to improve the delivery of complex, cross-cutting services in other areas can learn from the experience of applying Quality Improvement methods reported here.


Pearson, M., Hemsley, A., Blackwell, R., Pegg, L., & Custerson, L. (2017). Improving Hospital at Home for frail older people: insights from a quality improvement project to achieve change across regional health and social care sectors. BMC health services research, 17(1), Article ARTN 387.

Journal Article Type Article
Acceptance Date May 25, 2017
Online Publication Date Jun 5, 2017
Publication Date Jun 5, 2017
Deposit Date Mar 1, 2018
Publicly Available Date Oct 27, 2022
Journal BMC Health Services Research
Print ISSN 1472-6963
Electronic ISSN 1472-6963
Publisher Springer Verlag
Peer Reviewed Peer Reviewed
Volume 17
Issue 1
Article Number ARTN 387
Keywords Health Policy; Frail older people; Hospital at home; Quality improvement; Integrated care
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© The Author(s). 2017 Open Access This article is distributed under the terms of the Creative Commons Attribution 4.0<br /> International License (, which permits unrestricted use, distribution, and<br /> reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to<br /> the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver<br /> ( applies to the data made available in this article, unless otherwise stated.

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