Emergency care for older people
Research type
Research Study
Full title
Identifying models of care to improve outcomes for older people with emergency and urgent care needs
IRAS ID
246405
Contact name
Simon Conroy
Contact email
Sponsor organisation
University of Leicester
Duration of Study in the UK
2 years, 11 months, 31 days
Research summary
Introduction\nEmergency and Urgent care (EUC) is a major international issue. This study will address EUC from the point of an ambulance being called through to admission, and/or transfer out from hospital, focussing upon interventions in the Emergency Department for older people. Older people with EUC needs, in particular those with frailty, are especially vulnerable to harms that can arise in this care pathway. The first hours of an EUC episode can have a powerful influence; for example, the early identification of delirium should lead to more assertive treatment (e.g. intravenous instead of oral therapy), early mobilisation and a review of potentially harmful medication (anticholinergics). Evidence based solutions are required, but it is unlikely that there is one single optimal care model given the various contexts. Rather, there will be a range of possible solutions, with overarching principles that can be specified. We will undertake a series of linked studies, with a focus on implementation, which will provide robust, practical and focussed user-guidance about how best to organise the care pathway in Emergency Departments, so as to improve outcomes for older people with EUC needs. We will conduct an evidence synthesis, in-depth stakeholder interviews, analysis of patient pathways and outcomes, and sophisticated modelling of complex systems.\nMethods\nWorkpackage 1 – identifying best practice\nWP1.1 review of reviews of EUC interventions for older people, their outcomes and costs and any implementation factors identified.\nWP1.2 interviews of older people and their carers with recent experience of EUC, using the findings to ensure that the patient’s voice is at the centre of this study.\nWP1.3 clinician interviews about emerging interventions and key elements of high quality care.\nWorkpackage 2 – qualitative study of delivery of exemplar EUC pathways\nQualitative fieldwork (interviews, ethnography, documentary analysis) in 4-6 sites exemplifying promising pathways, to identify aspects relevant to transfer and adaptation of these models to other settings.\nWorkpackage 3 – routine patient level data analysis to describe EUC pathways, outcomes and costs\nAnalysis of linked databases to describe EUC pathways experienced by people aged 75+ across the Yorkshire and Humber region, 2010-2017. The aims are to assess which pathways deliver better patient outcomes than others, how pathways have changed over time, and what patient characteristics, demand factors and supply factors explain differences in outcomes and costs between patients, from place to place, and over time.\nWorkpackage 4 – modelling improvements to EUC pathways\nWe will develop a family of System Dynamics (SD) computer simulation models representing patient flow through the entire care process for different EUC pathways, using evidence from WP1 and WP2 and data from WP3. We will use these models to evaluate EUC interventions in different settings, in terms of their impact on patient outcomes and their knock-on effects in the wider care system.\nPPI\nPPI input will include high level strategic oversight of the study progress, assured by quarterly briefings to the PPI leads at the Executive Management Team meetings, complimented by ‘deep dive’ reviews of specific aspects of the project (for example scrutinising recruitment plans and interview schedules); quarterly consultations with the broader Leicester PPI forum to bring wider perspectives to the research; and focussed interaction with the East Midlands Centre for Ethnic Health Research.\nDissemination\nWe will involve an existing, established national stakeholder group focussing on urgent care of older people with frailty. A comprehensive dissemination strategy (including evidence summaries, high impact papers, national and international conferences, press releases, and national dissemination events) will be developed and targeted to key audiences who will be interested in the findings of this research, informed by the stakeholder group.\nImpact\nThe primary output will be a validated, patient-centred, System Dynamics model(s) adaptable to all health care systems through an easy to use interface, allowing modelling of emergency department interventions on the whole system.\nIn addition, we will provide outputs relevant to teams planning and delivering EUC for older people, and to academics. These will include a user-friendly classification of the different types of care pathway, summarising the strengths and limitations of different approaches and key points of information about optimising their delivery.
REC name
London - South East Research Ethics Committee
REC reference
18/LO/0930
Date of REC Opinion
29 Jun 2018
REC opinion
Unfavourable Opinion