Evaluating the Bristol Dementia Wellbeing Service

What we did

We analysed data from before and after the Bristol DWS was introduced (April 2014 – September 2018) as well as data from other geographical areas that didn’t have a similar service, to explore the impact of the service on various aspects of hospital admissions:

• admission and in-hospital mortality rates
• complexity of hospital admissions
• length-of-stay

What we found and what this means

This evaluation was commissioned as an exploratory project to test an analytical process that Bristol DWS hope to use further into the life of the service. The data used is based on a limited time period, due to limitations of the available HES data. The first year of service delivery was particularly challenging, as our first evaluation highlighted. While our report highlights some interesting results, it is clear that interpretation of these is done with considerable caution. We also note that these results only form part of the bigger picture of the DWS Service Evaluation, and should not be used in isolation.

With this in mind, there was a downward trend in the number of concurrent conditions that patients were admitted to hospital with after the Bristol DWS was introduced, compared to the other areas. There was also an immediate, moderate reduction in the hospital mortality for all admissions and ‘ambulatory care sensitive admissions’ when compared to control areas. Ambulatory care sensitive conditions (ACSCs) are conditions where effective community care and case management can help prevent the need for hospital admission. There was little evidence for an impact on the number of hospital admissions or length of stay, at least in the short term.

It is unlikely that the reduction in mortality was as a direct result of the service, as this would also have resulted in reduced length of stay. We wouldn’t expect to see the benefits so rapidly without further improvement over time as the service became more developed and integrated.

The dementia wellbeing service was established to improve quality of dementia care – reducing hospital admissions was never its sole purpose. More targeted interventions may be required to reduce hospital admissions for people with dementia.