Improving the effectiveness and efficiency of Health and social care services for vulnerable Older Brazilians (IHOB).

与英国一样，巴西拥有庞大的公共医疗体系，旨在为所有人提供良好的医疗服务。和英国一样，中国也面临着越来越大的财政压力，部分原因是人口迅速老龄化带来的健康需求。该项目旨在支持政策和实践，以提高提供服务的效率，优化巴西老年人的健康状况。重点减少老年人不必要住院和住院时间过长。这些措施占用了本可以更好地满足巴西老年人需求的服务资源。此外，不必要的住院使老年人面临新的健康风险，例如医院获得性感染，并且与大多数老年人声称的继续住在自己家中的偏好不一致。这项研究将制定一个明确的策略，以确定是否可以避免入院，或者是否可以缩短住院时间。为此，我们将参考英国等其他国家的研究和经验，并与巴西的政策制定者和实践者进行对话。然后，我们将分析一项名为ELSI的新全国调查的数据，以了解哪些老年人最有可能遇到这些问题，以及哪些情况会导致不必要的入院/长时间住院。巴西地理位置多样，从统计数据中可以学到的东西有限。考虑到这一点，我们将对贝洛奥里藏特和福塔莱萨这两个不同地区的城市进行更详细的案例研究。我们将向政策制定者和实践者询问当地是如何开展工作的——这将涉及许多问题，包括人们如何从家庭医生转到医院，以及他们如何出院。我们还将与社会护理人员密切合作，因为这对卫生服务的使用有很大影响。在每个城市，我们将从ELSI调查的参与者中选择大约20名老年人，并与他们和他们的家人谈论他们的经历。总之，这些信息应该提供了问题的清晰图景。我们还将关注解决方案。我们将借鉴其他国家的经验，特别是英国已经实施了一些相关的政策和项目。我们将回顾贝洛奥里藏特的一个有趣的试点项目（我们选择这里的一个原因）。该计划为体弱人士提供临时家居照顾服务，以帮助家庭成员学习如何自己提供这种照顾，并防止将来需要提供更密集和昂贵的服务。我们将仔细评估这个项目，考虑它的效果如何（在从业人员、老年人和家庭的眼中），以及它是否影响了不必要的入院/长期住院。我们还将使用不同健康状况的当地住院数据。我们将与当地官员密切合作，根据需要对项目提出修改建议。在所有的试点项目中，一个巨大的挑战是评估它们是否可以扩展到新的地点。贝洛奥里藏特是一个相对富裕的城市，拥有良好的服务，但贫穷的城市呢？考虑到这一点，我们将评估将试点项目（或修改版本，如果需要）扩展到福塔莱萨的可行性。我们将与政策制定者和从业者合作，开发一个本地版本的项目，并在6个月内将其应用于约20个家庭。如果它看起来很有希望，我们计划要求更多的资金，与这项研究分开，为一个更大的试点，我们可以更彻底地评估。在整个研究过程中，我们将与政策制定者和实践者密切合作。最后，我们将提供一份高级别国家报告，总结证据和我们所学到的知识，并为巴西地方卫生区的工作人员提供更具体的“工具包”。我们希望这也将为英国和其他国家应对这些重大挑战的努力提供启示。

Just as in the UK, Brazil has a large public healthcare system which aims to provide good care to all. And just as in the UK, it is facing mounting financial pressure, partly due to the health needs of a rapidly ageing population. This project aims to support policy and practice, with a view to improving the efficiency of service provision and optimising the health of older Brazilians.We will focus on reducing numbers of unnecessary admissions of older people to hospitals, as well as to residential care homes, and excessively long stays there. These take resources away from services that could better meet the needs of older Brazilians. Also, unnecessary hospital stays expose older people to new health risks, such as hospital acquired infections, and are at odds with the stated preference of most older people to remain living in their own homes.The study will develop a clear strategy for identifying whether an admission could have been averted, or a length of stay feasibly reduced. We will do this by looking at studies and experiences in other countries such as the UK and talking to policymakers and practitioners in Brazil. We will then analyse data from a new national survey called ELSI to see which older people are most likely to experience these problems and what situations trigger unneeded admissions/lengthy stays. Brazil is geographically diverse and there are limits to what can be learned from statistical data. With this in mind, we will develop more detailed case studies of 2 cities in different regions: Belo Horizonte and Fortaleza. We will ask policymakers and practitioners about how things are done locally -this will cover many issues, including how people are referred from family doctors to hospital and how they are discharged from hospital. We will also work closely with people in social care, as this strongly affects health service use. In each city we will select about 20 older people from participants in the ELSI survey and talk to them and their families about their experiences. Together, this information should provide a clear picture of the problem. We will also focus on solutions. We will look at experiences of other countries, especially the UK which has implemented a number of related policies and projects. We will review an interesting pilot project in Belo Horizonte (one reason we chose this location). The project offers temporary homecare services for frail people, in order to help family members learn how to provide this care themselves and with a view to preventing future need for more intensive and expensive service provision. We will carefully assess this project, considering how well it has worked (in the eyes of practitioners, as well as older people and families) and if it has effected unneeded admissions/long stays. We will also use local data on hospital admissions for different health conditions. Working closely with local officials, we will suggest modifications to the project, as needed.In all pilot projects a big challenge is assessing if they can be extended to new locations. Belo Horizonte is a relatively affluent city with good services, but what about poorer cities? Why this in mind, we will assess the feasibility of extending the pilot project (or a modified version, if required) to Fortaleza. Working with policymakers and practitioners, we will develop a local version of the project and apply it to about 20 families over 6 months. If it looks promising, we plan to ask for more funds, separately from this study, for a larger pilot which we can assess more thoroughly.We will work closely with policymakers and practitioner throughout the study. Towards the end, we will provide a high-level national report summarising the evidence and what we have learned, as well as more specific "toolkits" for people working in local Brazilian health districts. We hope this will also inform efforts in the UK and other countries to face these important challenges.