A realist and economic evaluation of care in leg ulceration
Research type
Research Study
Full title
A realist and economic evaluation of care in leg ulceration
IRAS ID
281143
Contact name
Fania Pagnamenta
Contact email
Sponsor organisation
The Newcastle upon Tyne Hospitals NHS Foundation Trust
Duration of Study in the UK
0 years, 11 months, 30 days
Research summary
The aim of this project is to provide explanations of when, for whom and in what circumstances leg ulcers are best cared for. This will inform local decision-makers on what needs to change to improve care.
A realist evaluation (Pawson & Tilley 1997) will be undertaken, which contends that intervention impacts (Outcomes) occur when certain causal processes (Mechanisms) are ‘triggered’ in the most favourable environments (Contexts). CMO configurations are used as explanatory theories that are refined and tested with empirical data.
This study will be operationalised in four phases (P1, P2, P3 and P4). P1 will involve the recruitment of six to eight patients, who will be purposefully selected from the Wound Healing Clinic because their leg ulcer has not healed. Their detailed case histories will be recorded from first presentation at a GP practice until they attend the Wound Healing Clinic for the first time. Experience suggests this can represent months or years, including multiple appointments across numerous settings. For each case, interviews will be undertaken with patients, carers and health care professionals; dressing changes will be observed and medical records and other relevant documents will be analysed.
P2 is a cost-consequences analysis to compare these six to eight journeys with the best practice leg ulcer pathway set out in the NHS Scenario (Betty’s story).
P3 will involve asking twenty-five community nurses to keep a structured diary for one week to understand how much of their time is dedicated to wound care. These nurses will be recruited from the same locality as the six to eight patients in P1.
P4 will consist of one workshop with key stakeholders (‘Advisory Board’ – further detail in C10) that will test the theories emerging from P1, P2 and P3. A model of care will be proposed alongside a medium-term strategy for care improvement and evaluation.
REC name
South West - Frenchay Research Ethics Committee
REC reference
20/SW/0177
Date of REC Opinion
7 May 2021
REC opinion
Further Information Favourable Opinion