Dependency Curve The where and when of assessment

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Dependency CurveThe where and when of assessment

• Alistair Main
• Consultant Geriatrician
• Chair of South Birmingham Older Peoples
  Partnership Group
• (South Quadrant Group)

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The Dependency Curve
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The Dependency Curve

• Its origins
• a simple teaching diagram used to convey the
  nature of acute illness in frail older people
• The model for service planning for older people
  used by a joint strategic group of the former SSD
  and BHA

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The Dependency CurveResponse to a crisis
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The Dependency CurveResponse to a crisis
D E P E N D E N C Y
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The Dependency CurveResponse to a crisis
D E P E N D E N C Y
T I M E
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The Dependency CurveResponse to a crisis
Threshold to admission
D E P E N D E N C Y
T I M E
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The Dependency CurveResponse to a minor crisis -
young person
Threshold to admission
D E P E N D E N C Y
T I M E
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The Dependency CurveResponse to a major crisis -
young person
Threshold to admission
D E P E N D E N C Y
T I M E
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The Dependency CurveResponse to a major crisis -
young person
Threshold to admission
D E P E N D E N C Y
Length of stay
T I M E
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Compressing LOS Young person

• Not much scope (Already very short)
• Mainly preventing unnecessary admissions
• Self management of trivia
• Better primary care management of chronic
  diseases in younger people eg COPD
• Improved responsiveness of primary care
• reverse recent increased trends in 999 calls

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The Dependency CurveResponse to a minor crisis -
older person
Threshold to admission
D E P E N D E N C Y
Young person
T I M E
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The Dependency CurveResponse to a minor crisis -
older person
Threshold to admission
D E P E N D E N C Y
High Baseline dependency
Young person
T I M E
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The Dependency CurveResponse to a minor crisis -
older person
Threshold to admission
D E P E N D E N C Y
High Baseline dependency - Osteoarthritis and
limited mobility - Housebound - Carer stress -
Mild cardiac failure
(Young person)
T I M E
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The Dependency CurveResponse to a minor crisis -
older person
Threshold to admission
D E P E N D E N C Y
Minor crisis on top of background dependency
complex admission
Young person
T I M E
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The Dependency CurveResponse to a minor crisis -
older person
Threshold to admission
D E P E N D E N C Y
Acute problem makes background worse - need for
acute care, attention to backgound problems and
rehabilitation
Young person
T I M E
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The Dependency CurveResponse to a minor crisis -
older person
Threshold to admission
D E P E N D E N C Y
Slower recovery
Young person
T I M E
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The Dependency CurveResponse to a minor crisis -
older person
Threshold to admission
D E P E N D E N C Y
Decision - medically fit - discharge
Young person
T I M E
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The Dependency CurveResponse to a minor crisis -
older person
Threshold to admission
D E P E N D E N C Y
Premature discharge fails
Young person
T I M E
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The Dependency CurveResponse to a minor crisis -
older person
Threshold to admission
D E P E N D E N C Y
Decision - medically fit has stayed too long
- institutionalise
Young person
T I M E
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The Dependency CurveResponse to a minor crisis -
older person
Threshold to admission
D E P E N D E N C Y
Premature and rushed decision to institutionalise
Young person
T I M E
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The Dependency CurveResponse to a minor crisis -
older person
Threshold to admission
D E P E N D E N C Y
Ideal
Young person
T I M E
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The Dependency CurveResponse to a minor crisis -
older person
Threshold to admission
D E P E N D E N C Y
Practical
Young person
T I M E
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The Dependency CurveResponse to a minor crisis -
older person
Threshold to admission
D E P E N D E N C Y
Longer LOS
Young person
T I M E
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In Older PersonMuch more scope to intervene.
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The Dependency CurveInterventions
Threshold to admission
D E P E N D E N C Y
Proper assessment Community support Health
promotion Proactive health care NSF - Standard 8
A
Young person
T I M E
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The Dependency CurveInterventions
Threshold to admission
D E P E N D E N C Y
Crisis intervention - Intermediate Care -
Intensive support at home NSF Standard 3, 6
A
B
Young person
T I M E
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The Dependency CurveInterventions
Threshold to admission
D E P E N D E N C Y
C
Proper assessment in AE Appropriate placement in
hospital Diversion to alternative care NSF
Standard 3,5,6
A
B
Young person
T I M E
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The Dependency CurveInterventions
Threshold to admission
D
D E P E N D E N C Y
C
Better Care in hospital Standard 4 and 5,6,7
A
B
Young person
T I M E
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The Dependency CurveInterventions
Threshold to admission
D
E
D E P E N D E N C Y
C
Time and help to recover Better discharge Support
at Home Prevent institionalisation Standard 3, 7
and 8
A
B
Young person
T I M E
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The Dependency Curve

• Its adoption by BHA and BSS
• The bed-blocking crisis
• Joint Working Group (BHA and BSS)
• Used as strategic model to tackle the problems
• First Report Nov 2001
• Second report April 2002
• reinforced by They deserve Better
• Revisited as a model for planning services in
  SBPCTs Joint Planning Group

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Overall aims

• Improve general health and well-being of older
  people
• reduce admissions
• expedite better discharges
• reduce the need for institutionalisation

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The Dependency Curve

• A model for preventive care, health and social
  well-being and reactive care
• A model for the when and where of
• Assessment
• Intervention
• Measuring the impact of intervention

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The Dependency Curve