Health services utilization associated with cognitive impairment and dementia in older patients undergoing post-acute rehabilitation.

OBJECTIVE: To investigate the relationship between levels of cognitive impairment and health services utilization in older patients undergoing post-acute rehabilitation. DESIGN: Cross-sectional study. SETTING: Post-acute rehabilitation facility. PARTICIPANTS: Patients (N = 1764) aged 70 years and older admitted over 3 years. MEASUREMENTS: Sociodemographic, medical, and functional data were collected upon admission. Based on discharge diagnoses, patients were classified as cognitively intact, cognitively impaired with no dementia (CIND), and demented. RESULTS: Dementia and CIND were diagnosed in 425 (24.1%) and 301 (17.1%) patients, respectively. Gradients from cognitively intact to cognitively impaired to demented patients were observed in median length of stay (19, 22, and 25 days, P < .001), and institutionalization rates at discharge (4.2%, 7.6%, and 28.8%, P < .001). Among patients discharged home, similar gradients were observed in utilization of home care (68.2%, 79.7%, and 83.3%, P < .001) and day care (3.1%, 7.1%, and 14.3%, P < .001). After adjustment, compared with cognitively intact patients, only those with dementia still had longer stays (+2.7 days) and increased odds of institutionalization (adjOR 6.1, 95% CI 4.0-9.3, P < .001). Among patients discharged home, use of home and day care remained higher in those with dementia (adjOR 1.8, 95% CI 1.2-2.7, P = .005, and adjOR 1.8, 95% CI 1.2-2.7, P = .005, respectively), while CIND patients had higher odds of using home care (adjOR 1.6, 95% CI 1.1-2.4, P = .028). CONCLUSION: Among patients undergoing post-acute rehabilitation, those with dementia had increased use of both institutional and community care, whereas those with CIND had increased use of home care services only. Future studies should investigate specific strategies susceptible to reduce the related burden on health care systems.

Market-Based Instruments for ecosystem services: institutional innovation or renovation?

Recent years have seen widespread experimentation with market-based instruments (MBIs) for the provision of environmental goods and ecosystem services. However, little attention has been paid to their design or to the effects of the underlying pro-market narrative on environmental policy instruments. The purpose of this article is to analyze the emergence and dissemination of the term "market-based instruments" applied to the provision of environmental services and to assess to what extent the instruments associated are genuinely innovative. The recommendation to develop markets can lead in practice to a variety of institutional forms, as we show it based on the example of payments for environmental services (PES) and biodiversity offsets, two very different mechanisms that are both presented in the literature as MBIs. Our purpose is to highlight the gap between discourse and practice in connection with MBIs.

IPH response to Review of Maternity Services in Northern Ireland

IPH responded to the Department of Health, Social Services and Public Safety consultation on a draft maternity strategy for Northern Ireland. The strategy contains a number of proposals, which, if implemented, will significantly change how maternity services are delivered in the future. The draft strategy aims to provide women, professionals, commissioners and policy makers with a clear pathway for maternity services from preconceptual care through to postnatal care.  It places an emphasis on early direct contact with a midwife and a better understanding of the role of the midwife and obstetricians. It sets out clear recommendations for tackling public health issues such as obesity, smoking and alcohol abuse in pregnancy; providing more choice; providing care closer to home and ensuring safe, high quality care tailored to meet the needs of the woman.

RQIA Review of the implementation of Promoting Quality Care (PQC) Good Practice Guidance on the Assessment and Management of Risk in Mental Health and Learning Disability Services (PDF1.07MB)

Overview Report October 2012

Improving Dementia Services in Northern Ireland - A Regional Strategy - November 2011

Improving Dementia Services in Northern Ireland - A Regional Strategy - November 2011

Improving services for general paediatric surgery (PDF 97KB)

Policy and Standards of Care for Paediatric ENT Surgery in Northern Ireland

Improving services for paediatric ENT Surgery (PDF 95KB)

Policy and Standards of Care for Paediatric ENT Surgery in Northern Ireland

Statistics on Smoking Cessation Services in Northern Ireland: 08/09: Pre Release Access List

2008/09 Pre-Release Access List

A Workforce Learning Strategy for the Northern Ireland Health and Social Care Services 2009-2014 (PDF 318KB)

A Workforce Learning Strategy for the Northern Ireland Health and Social Care Services 2009-2014