Models of generalist and specialist care in smaller acute hospitals: an exploratory study

Vaughan L, Bardsley M, Bell D, Davies M, Goddard A, Imison C, Melnychuk M, Morris S, Rafferty AM
Record ID 32016000929
Authors' objectives: People with multiple health problems, particularly those over age 65, are the heaviest users of hospital services. There are growing concerns that the care they receive from hospital doctors is not optimal for their needs. They are less likely, for example, to receive an accurate diagnosis or the most appropriate treatment. One reason for this is the trend for doctors to become more specialised, often focusing on the treatment of particular diseases or problems with single organs of the body, potentially leading to poorer care for patients with multiple diseases. As a consequence, there has been a call for a growth in the number of doctors who have broader range of skills medical generalists. While people recognise the need for more medical generalists in hospital, we do not know how many more are needed. Nor do we have a clear idea of the number of patients who need this type of generalist care. Ways in which care is managed by generalist and specialist doctors in hospitals also vary, and we do not know whether some ways of working are better than others. We aim to answer these questions by looking at the different models of medical care used in smaller hospitals. For example, how many generalist and specialist doctors they employ and how they work together to meet the needs of patients. We have chosen smaller hospitals for a number of reasons. Most importantly, the people who use them tend to be older and more vulnerable and thus their need for generalist care is greater. This makes them an excellent place to explore the different models of medical care and how they impact on patients and staff. This study will be conducted over 30 months and will have five main work packages: 1. Understanding the way in which doctors work We will survey smaller hospitals to find out about the numbers of generalist and specialist doctors, and how they work together. The different models of care will be grouped and then investigated by visiting 15 hospitals and looking in more detail at processes of care. 2. Understanding the types of patients We will use data on people attending smaller hospitals, including their age and diagnosis to find out what proportion of patients would benefit from generalist care and what proportion need different types of specialist care. 3. Investigating the costs We will identify and compare the costs of different types of medical care. 4. Understanding the strengths and weaknesses of the different models We will talk to groups of staff, patients and carers about the different models to get their views and ask patients, carers and staff to choose their preferred model. We will see if we can find any differences between the different models by looking at what happens to patients and their health after their admission to hospital. 5. Analysis We will bring all these findings together to draw conclusions about the different models of medical care in hospital and how well they are meeting the needs of patients. We will make recommendations about how doctors work in smaller hospitals. The work will be undertaken by people with significant expertise in the different areas we are studying and the type of research we are undertaking. The results of this study will be shared widely through study reports, journals, websites, social media and events. We also use professional, NHS and policy networks to ensure that people who lead organisations and make policy are aware of our findings.
Project Status: Completed
Year Published: 2021
English language abstract: An English language summary is available
Publication Type: Not Assigned
Country: England, United Kingdom
MeSH Terms
  • Delivery of Health Care
  • Specialization
  • Hospitals
  • Health Care Economics and Organizations
  • General Practice
Organisation Name: NIHR Health Services and Delivery Research programme
Contact Address: NIHR Journals Library, National Institute for Health and Care Research, Evaluation, Trials and Studies Coordinating Centre, Alpha House, University of Southampton Science Park, Southampton SO16 7NS, UK
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