A demand and capacity model for home-based intermediate care: optimizing the ‘step down’ pathway

Step-down intermediate care provides a bridge between acute hospital admission and return to normal function. The purpose is to enable patients to leave hospital as soon as medically fit, avoiding costs of delayed discharge and consequent risks to patients’ health and wellbeing. Determining optimum capacity for resource planning of intermediate care requires balancing the 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 number of patients that can be concurrently accommodated. To our knowledge, this is the first simulation study to model the patient pathway from hospital discharge through to provision of home visits. The model supports short-term resource planning in a major English healthcare system.