Self-Management of Chronic Illness Among Chinese Immigrants: An Integrative Review.

Worldwide, healthcare systems are in crisis with hospitals under increasing pressure due to large elective activity backlogs and unsustainably high bed occupancy (Samadbeik et al. ). In countries such as England, the plan is to reduce the burden on hospitals by shifting care to the community (NHS England ). Despite policy ambitions that upscaling community health services (CHS) can reduce pressure on hospitals, there is currently very little evidence to support this (NICE ; Shi et al. ; Goff et al. ; Parkinson et al. ). One avenue through which community care is hypothesised to reduce the burden on hospitals is through intervening early to prevent deteriorations in health that would otherwise lead to avoidable emergency hospital presentations. This potential is highlighted in a recent study which estimated that 22% of emergency attendances are potentially avoidable (Jamieson et al. ). However, there are significant staffing shortages in CHS (Parkinson et al. ), which limits the extent to which these services can be responsive and support the desired strategic shift. Therefore, it is important to identify whether and for which types of patients CHS can avoid subsequent emergency hospital attendance, as this could identify opportunities to allocate the limited available community staff to the situations that would impact patients and hospital services the most. CHS for adults in England cover a wide range of services including district nursing, specialist long‐term condition nurses, occupational therapy, physiotherapy, and rehabilitation (NHS England ). Whilst a range of staff are involved in the provision of CHS, 73% of clinical staff are nurses or nursing support staff (NHS England ), with the majority of services being nurse‐led. The sector plays a crucial role in treating and managing people's health needs in their homes and local communities, supporting people to live independently in their own homes and accounting for 13% of England's annual National Health Service (NHS) activity (The Kings Fund ). Services cover both step‐up care, supporting patients with care needs that have escalated beyond the level that can be managed in primary care, and step‐down care following hospital discharge (NHS England ). A large body of literature has explored the impact of delays in receipt of step‐down care following hospital discharge, mainly examining outpatient and physician follow‐up, with mixed findings. Recent systematic reviews conclude that whilst the receipt of follow‐up care after discharge is generally found to be associated with a reduced risk of readmission, there is less evidence to support the importance of early timing of that follow‐up care for all patients (Bai et al. ; Balasubramanian et al. ). A meta‐analysis found evidence to support the importance of early post‐discharge follow‐up only for older patients and those with certain chronic conditions, recommending that early follow‐up care is therefore targeted at these high‐risk groups rather than universally implemented (Balasubramanian et al. ). Step‐down CHS care in England operates a targeted model, with acute providers referring patients who they deem to be in need to CHS following discharge. These patients then receive care from CHS in conjunction with outpatient and/or physician follow‐up, depending upon the reason for initial admission. There is, however, much less evidence on the impact of delays in care receipt earlier in the community care pathway, when patients are initially referred to CHS from primary care. It is unknown whether delays in care at this stage are associated with increased risk of hospital attendance.