Models of Generalist and Specialist Care in Smaller Acute Hospitals
Research type
Research Study
Full title
Models of Generalist and Specialist Care in Smaller Acute Hospitals: An Exploratory Study
IRAS ID
191393
Contact name
Louella Vaughan
Contact email
Sponsor organisation
Nuffield Trust
Duration of Study in the UK
2 years, 6 months, 0 days
Research summary
Background: The increasing numbers of older and more complex patients requiring emergency medical admission has prompted a call for the revival in the role of general physicians. Smaller hospitals provide an ideal environment in which to investigate models of medical generalist care, as their patient population is older and more vulnerable, while their size creates constraints on their income, capacity and staffing.
Aim: To investigate the strengths and weaknesses of the current models of medical generalism in smaller hospitals from the perspective of patients, professionals and service.
Methods: Mixed-methods approach, with interlinking work packages (WPs).
WP1 - Describing Models of Medical Generalism: Scoping and mapping exercise to create typology of the models of generalist care in smaller hospitals. Exemplar sites of the different models will be purposively sampled and investigated using site visits, day of care survey, interviews and document reviews.
WP2 - Understanding Case Mix of Generalist Medical Care: Classification of ‘specialist’ and ‘generalist’ patients will be created and tested using Hospital Episode Statistics, and then used as the basis of descriptive analysis of hospital workload.
WP 3 - Investigating the Economic Costs: Detailed economic analysis of the economic costs of the different models of generalist care.
WP 4 - Understanding the Strengths and Weaknesses of Models of Generalism: Strengths and weaknesses of the different models of generalism will be explored from patient, professional and service perspectives. This will include use of focus groups, stakeholder workshops, a discrete choice experiment and an assessment of the alignment of case mix and skills mix in different hospitals.
WP 5 - Analysis and Synthesis: Results and outcomes from the work packages will be drawn together to provide an overarching analysis and synthesis. The scoping portion of the study will be assessed, with a view to undertaking a national study of medical generalism.REC name
Yorkshire & The Humber - Leeds East Research Ethics Committee
REC reference
16/YH/0361
Date of REC Opinion
17 Aug 2016
REC opinion
Favourable Opinion