Appealing and logical, but still in need of evaluation

Intermediate care describes care given after traditional primary care and self care, but before or instead of the care that is available deep inside large acute hospitals.1 It seems to address one of the limitations of many health systems: the lack of a wide range of specific and integrated facilities that can address complex needs. Going too far along a clinical pathway into a large acute hospital or remaining there for too long because no alternative facilities exist is wasteful, dangerous, and inconvenient. Examples of services that are intermediate between traditional primary care and secondary care include preadmission assessment units, early and supported discharge schemes, community hospitals, domiciliary stroke units, hospitals at home, and rehabilitation units.2

Although an important feature of intermediate care is its location, the term intermediate also refers to care that is organised and delivered by teams of different professionals and organisations. The progressive erosion of barriers between doctors and other clinical professionals, between social and health services, and between statutory and non-statutory services provides important opportunities to smooth the many interfaces throughout …