A Service Model For Delivering Care Closer to Home.

Upton Surgery (Worcestershire) has developed a flexible and responsive service model that facilitates multi-agency support for adult patients with complex care needs experiencing an acute health crisis. The purpose of this service is to provide appropriate interventions that avoid unnecessary hospital admissions or, alternatively, provide support to facilitate early discharge from secondary care. Key aspects of this service are the collaborative and proactive identification of patients at risk, rapid creation and deployment of a reactive multi-agency team and follow-up of patients with an appropriate long-term care plan. A small team of dedicated staff (the Complex Care Team) are pivotal to coordinating and delivering this service. Key skills are sophisticated leadership and project management skills, and these have been used sensitively to challenge some traditional roles and boundaries in the interests of providing effective, holistic care for the patient. This is a practical example of early implementation of the principles underlying the Department of Health’s (DH) recent Best Practice Guidance, ‘Delivering Care Closer to Home’ (DH, July 2008) and may provide useful learning points for other general practice surgeries considering implementing similar models. This integrated case management approach has had enthusiastic endorsement from patients and carers. In addition to the enhanced quality of care and experience for the patient, this approach has delivered value for money. Secondary care costs have been reduced by preventing admissions and also by reducing excess bed-days. The savings achieved have justified the ongoing commitment to the service and the staff employed in the Complex Care Team. The success of this service model has been endorsed recently by the ‘Customer Care’ award by ‘Management in Practice’. The Surgery was also awarded the ‘Practice of the Year’ award for this and a number of other customer-focussed projects.

Application of the WRF-Chem Model for a High Ozone Episode in SW Poland – Preliminary Results

The Weather Research and Forecasting model, integrated online with chemistry module, is a multi-scale model suitable for both research and operational forecasts of meteorology and air quality. It is used by many institutions for a variety of applications. In this study, the WRF v3.5 with chemistry (WRF-Chem) is applied to the area of Poland, for a period of 3-20 July 2006, when high concentrations of ground level ozone were observed. The meteorological and chemistry simulations were initiated with ERA-Interim reanalysis and TNO MACC II emissions database, respectively. The model physical parameterization includes RRTM shortwave radiation, Kain-Fritsch cumulus scheme, Purdue Lin microphysics and ACM2 PBL, established previously as the optimal configuration. Chemical mechanism used for the study was RADM2 with MADE/SORGAM aerosols. Simulations were performed for three one-way nested domains covering Europe (36 km x 36 km), Central Europe (12 km x 12 km) and Poland (4 km x 4 km). The results from the innermost domain were analyzed and compared to measurements of ozone concentration at three stations in different environments. The results show underestimation of observed values and daily amplitude of ozone concentrations.

Future Air Quality Related Health Effects in Europe and the Nordic Region—Sensitivity to Changes in Climate, Anthropogenic Emissions, Demography and Building Stock

Future changes in population exposures to ambient air pollution are inherently linked with long-term trends in outdoor air quality, but also with changes in the building stock. Moreover, the burden of disease is further driven by the ageing of the European populations. This study aims to assess the impact of changes in climate, emissions, building stocks and population on air pollution related human health impacts across Europe in the future. Therefore an integrated assessment model combining atmospheric models and health impacts has been setup for projections of the future developments in air pollution related premature mortality. The focus is here on the regional scale impacts of exposure to surface ozone (O3), Secondary Inorganic Aerosols (SIA) and primary particulate matter (PPM).