A Demand and Capacity Model For Home-Based Intermediate Care: Optimizing The 'Step Down’ Pathway

Intermediate care supports timely discharge from hospital for patients with complex healthcare needs. The purpose of 'step-down’ care is to enable patients to leave hospital as soon as medically fit, avoiding costly discharge delays and consequent risks to patient health and wellbeing. Determining optimal intermediate care capacity requires balancing costs to both acute hospital and community care providers. Too much community capacity results in underutilized resources and poor economic efficiency, while too little risks excessive hospital discharge delays. Application of discrete-time simulation shows that total costs across the acute-community interface can be minimized by identifying optimal community capacity in terms of the maximum number of patients for which home visits can be provided by the service. To our knowledge, this is the first simulation study to model the patient pathway from hospital discharge through to community visits. Simulation modeling has supported short-term resource planning in a major English healthcare system.