For older people and those with complex needs, the transitional period of moving from hospital to home is risky. Some patients, (as many as one in five) experience an adverse event, such as a fall or infection during this time, increasing their risk of being readmitted to hospital. The aim of this research is to improve the safety and experience of care for older patients as they move from hospital to home. The duration of the programme is five and a half years and involves six work packages; from outlining and understanding the problem, describing best practices around transitions, co-designing and refining an intervention and finally evaluation. As of January 2020, we have completed four of these work packages.
1st January 2017 – 1st July 2022
Status – complete.
This was the first of our six WPs where we explored patient’s and caregiver’s experiences of care transitions from hospital to home.
Through our interviews and observations in hospital and in patients’ homes we found that patients and carers:
- Valued feeling cared for and supported in hospital;
- Felt a loss of autonomy and independence in hospital;
- Found that communication was poor;
- Were often confused about medicines;
- Found discharges difficult (either because it was sudden and unexpected or drawn out and disorientating)
- Felt that community services had not received them as they had hoped;
- Did not feel involved in their care.
See the Publications and Outputs section below for all reports and conference presentations relating to this work package. We are currently finalising our findings report for journal submission.
Click here for our published protocol paper. Our findings paper is being written…
Status – complete
This involved trying to understand how teams (primary care and hospital) manage to achieve low hospital re-admission rates for older people. Our key question was: What do they do to deliver safe care and to involve older patients during their transition home?
We used routine data to identify wards and community teams who have low levels of hospital re-admissions. We then interviewed these teams.
Through our interviews with staff we found that:
- Teams with established and trusted relationships that involve sharing of knowledge and concerns and where members value and understand each other’s roles;
- Working creatively within inadequate discharge systems to ‘pick up the pieces’ and be ‘detectives’;
- Empowering patients and helping them manage their own care and to navigate through the systems
- Staff (including wider administrative team members) getting to know patients well to help with managing risk of hospital re-admissions.
See the Publications and Outputs section below for all reports and conference presentations relating to this work package. Our findings paper is due to be published very soon in BMC Health Services Research. See the Publications and Outputs section below for updates.
Click here for our recently published protocol paper. Our findings paper is being written…
Status – complete
We have developed a measure called PACT-M, which is made up of two parts:
- Part 1 includes 9 questions mostly relating to hospital care. This will be administered shortly after hospital discharge.
- Part 2 includes 8 questions about managing health care at home and this will be administered at around one month after discharge from hospital.
Both parts of the measure include questions about adverse events such as falls and infections.
The measure will be used in testing out the effectiveness of our intervention in WP6.
Status – complete
Prior to working with stakeholders we took the findings from WP1 and WP2 to perform a mapping exercise to explore the key activities that patients need to undertake after discharge to manage their own health effectively. We then looked at opportunities that are available to prepare patients for these activities while they are in hospital. The mapping process was called FRAM (see outputs below for our paper) and the key activities that we identified for the intervention are:
2) health and well-being;
3) Getting moving;
4) knowing what to expect after discharge.
We aim to support older patients to be more involved in their care to ‘know more’ and ‘do more’ in hospital in advance of their discharge home. We involved a number of stakeholders (staff from health and social care and the third sector, and members of our patient panel) to help design the intervention. The intervention called ‘Your Care Needs You! comprises a patient-held booklet, a short patient film and enhanced discharge documents. Staff will be supported to encourage patient involvement across the four activities through behaviour change techniques. We conducted a formative evaluation of the intervention and made changes based on patient and staff feedback.
Click here for our most recent publication that explains how we think about patient involvement and complex health care systems.
We are currently writing reports on the development and pilot testing of the intervention and when these are available we will upload them to the Publications and Outputs section below.
Click on the image below to see a visual summary of our intervention development work.
Status – Complete
The trial feasibility study was conducted between November 2019 and April 2020. It involved nine wards from three hospital trusts. We have completed all data collection and follow-up and currently analysing the results. Knowledge gained from the feasibility trial has been invaluable and has been incorporated in the processes for the final full cluster randomised controlled trial in WP6.
A paper reporting reporting the protocol for this study in press with Pilot and Feasibility Studies and when published will be put on our webpage in the Publications and Outputs section below.
WP6 - A cluster randomised controlled trial of the effectiveness and cost-effectiveness of PACT and parallel process evaluation
Status – delayed start due to COVID-19. Anticipate starting in early 2021.
Here we will assess the effectiveness and cost-effectiveness of the PACT intervention with in a cluster randomised controlled trial. Our main outcome measure will be hospital re-admissions rates comparing wards where the PACT has been delivered to those where usual care is provided. We will also evaluate whether the PACT intervention improves patient experience, safety and quality of life using the PACT-M (see WP3 for more information) and reduces NHS costs.
Going home from hospital – Patient experiences (patients and carers findings)
|A qualitative study exploring the experience and involvement of older people moving from hospital to home – presented at the HSR UK 2018 conference.
|Hardicre, N. K., et al. (2017). Partners at Care Transitions (PACT) Exploring older peoples’ experiences of transitioning from hospital to home in the UK: protocol for an observation and interview study of older people and their families to understand patient experience and involvement in care at transitions, BMJ, 10.1136/bmjopen-2017-018054||Paper||WP1||Click here|
|Murray, J., et al. (2019). “How older people enact care involvement during transition from hospital to home: A systematic review and model.” Health Expect 22(5): 883-893.||Paper||WP1|
|Baxter, R., et al. (2018). “Partners at Care Transitions: exploring healthcare professionals’ perspectives of excellence at care transitions for older people.” BMJ Open 8(9): e022468.||Paper||WP1||Click here|
|Baxter, R., Shannon, R., Murray, J. et al. Delivering exceptionally safe transitions of care to older people: a qualitative study of multidisciplinary staff perspectives. BMC Health Serv Res 20, 780 (2020).||Paper||WP2||Click here|
|Partners at Care Transitions? A qualitative study exploring the experience and involvement of older people moving from hospital to home.||Poster||WP2||Click here|
|Oikonomou, E., et al. (2019). “Developing a measure to assess the quality of care transitions for older people.” BMC Health Serv Res 19(1): 505.||Paper||WP3||Click here|
|O’Hara, J. K., et al. (2020). “‘Handing over to the patient’: A FRAM analysis of transitional care combining multiple stakeholder perspectives.” Appl Ergon 85: 103060.||Paper||WP4||Click here|
Click here for information on our PACT Patient and Public Involvement Panel.
This summary presents independent research funded by the National Institute for Health Research (NIHR) under the NIHR Programme Grant for Applied Research (PGfAR) Award, reference RP-PG-1214-20017. Partners at Care Transitions (PACT): Improving Patient Experience and Safety at Transitions of Care.
We have published two papers (see the Publications and Outputs section below) from the work package reporting on the development and also the validation of the PACT-M measure.