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Health care delivery, economics and global health care
Original research
Impact of a community-based cardiovascular disease service intervention in a highly deprived area
  1. Jennifer Downing1,
  2. Tanith C Rose2,
  3. Pooja Saini3,
  4. Bashir Matata4,
  5. Zoe McIntosh5,
  6. Terence Comerford6,
  7. Keith Wilson4,
  8. Allan Pemberton6,
  9. Lesley M Harper7,
  10. Matthew Shaw4,
  11. Konstantinos Daras8,
  12. Ben Barr2
  1. 1 Department of Molecular and Clinical Pharmacology, University of Liverpool, Liverpool, UK
  2. 2 Department of Public Health and Policy, University of Liverpool, Liverpool, UK
  3. 3 School of Natural Sciences and Psychology, Liverpool John Moores University, Liverpool, UK
  4. 4 Research Department, Liverpool Heart and Chest Hospital NHS Foundation Trust, Liverpool, UK
  5. 5 Knowsley Community Services, Liverpool Heart and Chest Hospital NHS Foundation Trust, Liverpool, United Kingdom
  6. 6 NIHR CLAHRC NWC, University of Liverpool, Liverpool, UK
  7. 7 Department of Health Service Research, University of Liverpool, Liverpool, UK
  8. 8 Department of Geography and Planning, University of Liverpool, Liverpool, UK
  1. Correspondence to Dr Jennifer Downing, Molecular and Clinical Pharmacology, University of Liverpool, Liverpool L69 3GL, UK; j.downing{at}liverpool.ac.uk

Abstract

Objective To examine the effects on emergency hospital admissions, length of stay and emergency re-admissions of providing a consultant-led, community-based cardiovascular diagnostic, treatment and rehabilitation service, based in a highly deprived area in the North West of England.

Methods A longitudinal matched controlled study using difference-in-differences analysis compared the change in outcomes in the intervention population, to the change in outcomes in a matched comparison population that had not received the intervention, 5 years before and after implementation. The outcomes were emergency hospitalisations, length of inpatient stay and re-admission rates for cardiovascular disease (CVD).

Results Findings show that the intervention was associated with 66 fewer emergency CVD admissions per 100 000 population per year (95% CI 22.13 to 108.98) in the post-intervention period, relative to the control group. No significant measurable effects on length of stay or emergency re-admission rates were observed.

Conclusion This consultant-led, community-based cardiovascular diagnostic, treatment and rehabilitation service was associated with a lower rate of emergency hospital admissions in a highly disadvantaged population. Similar approaches could be an effective component of strategies to reduce unplanned hospital admissions.

  • healthcare delivery
  • quality and outcomes of care
  • heart failure
  • chronic coronary disease
  • cardiac rehabilitation
http://creativecommons.org/licenses/by-nc/4.0/

This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/.

https://doi.org/10.1136/heartjnl-2019-315047

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    Footnotes

    • JD and TCR are joint first authors.

    • Contributors JD and TR are joint first authors. JD and BB conceived the study design. All the team developed the study and contributed to finalising the research question. TR and BB contributed to analysis, KD to indicators and MS to local data provision. BM and ZM supported this work providing information of the nature of the intervention, contextual information and fact-checking the final draft. JD, TR and BB drafted the manuscript and all other authors critically assessed and contributed to the paper and agreed the final manuscript. The public advisers KW, TC and AP contributed throughout the paper and we look forward to continuing our work with them in the future. BB is guarantor for the study. The corresponding author attests that all listed authors meet authorship criteria and that no others meeting the criteria have been omitted.

    • Funding This study was supported by the National Institute for Health Research Collaboration for Leadership in Applied Health Research and Care North West Coast (NIHR CLAHRC NWC).

    • Disclaimer The views expressed in this manuscript are those of the authors and do not represent NHS, the NIHR, the Department of Health and Social Care or Liverpool Heart and Chest NHS Foundation Trust. There are no other relationships or activities that could appear to have influenced the submitted work.

    • Competing interests BM and ZM are employed by Liverpool Heart and Chest NHS Foundation Trust, the provider of KCVDS, and were involved in providing information about the nature of the intervention and providing contextual information upon request when interpreting the results. AP is an elected governor and KW is employed as a patient ambassador at Liverpool Heart and Chest NHS Foundation Trust. Both were involved as public advisors.

    • Patient consent for publication Not required.

    • Provenance and peer review Not commissioned; externally peer reviewed.

    • Data availability statement All data relevant to the study are included in the article or uploaded as supplementary information.