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Moving Care Closer to Home: An evaluation of the costs and effects of different models of caring for acutely ill children at home.

Callery, Peter; Kyle, Richard G; Banks, Michele; Weatherly, Helen; Kirk, Susan; Campbell, Malcolm; Powell, Peter; Ewing, Carol


Peter Callery

Richard G Kyle

Michele Banks

Helen Weatherly

Susan Kirk

Malcolm Campbell

Peter Powell

Carol Ewing


Part of the vision of the National Service Framework for Children and Young People (NSF Standard 6) is to see:

“Children and young people who are ill receiving timely, high quality and effective care as close to home as possible.”

Service developments designed to reduce admissions in acute episodes include home nursing by Community Children’s Nursing Teams (CCTs) and monitoring in Observation and Assessment Units (OAUs) where children can be observed in a hospital environment for up to 6 hours without admission. Service models have been developed at the local level with the result that a complex pattern of different models of CCT and OAUs has emerged across England.

There is limited evidence about the relative effectiveness of different models of CCT and OAU and even less about the interaction between CCTs and OAUs. There is therefore a key gap in the knowledge to underpin policy decisions about the development of CCTs and OAUs to achieve the vision of the National Service Framework

Aims of the project

•To assess how effectively different models of Community Children’s nursing Teams (CCTs) provide alternative care to hospital admission during acute illness
•To examine the CCTs interaction with other services including Children’s Observation and Assessment Units (OAUs)
•To determine the costs associated with different models of service


There are two main stages to the project.

Stage 1 consists of:
1.A survey of all CCTs and children’s OAUs based in a former Strategic Health Authority (SHA) area
2.Analysis of hospital admissions data for the three commonest reasons for all children attending hospital across the SHA area (breathing difficulties, diarrhea and feverish illness)

The SHA area selected includes social and ethnic diversity and a range of service models.

In Stage 2 we describe service models and explore their relationships with the number and duration of children’s hospital admissions. We also compare effects and costs of service models and examine the views of parents, children and professionals. This is achieved via case studies of three purposefully sampled CCTs from the SHA. Data will be collected by multiple methods across the sites including documentary analysis, survey, qualitative interviewing and the secondary analysis of routinely collected data. In detail the methods are:
1.A postal family user survey
2.Semi-structured interviews with 30 school age children and separate interviews with their parents/ carers
3.Semi-structured interviews with 30 purposefully sampled health service professionals
4.Documentary analysis of protocols, guidelines, pathways, local delivery plans and other documents relating to general acute care provision
5.Secondary analysis of routinely collected CCT caseload data

Report Type Project Report
Publication Date 2011
Deposit Date Jan 22, 2015
Peer Reviewed Not Peer Reviewed
Keywords Acute illness; Case study; Community children's nursing; Home care
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