Overview

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.

Timescales

1st January 2017 – 1st July 2022

Work Packages

WP1 - Patient and caregiver experience of transitions

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.

We presented the findings from WP1 at this year’s Health Services Research UK conference. Click on the poster image below to view:


 

Click here for our published protocol paper. Our findings paper is being written…

WP2 - Staff Interviews

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.

We presented the findings from WP2 at this year’s Health Services Research UK conference. Click on the poster image below to view…

 

Click here for our recently published protocol paper. Our findings paper is being written…

WP3 – Developing a patient reported measure to assess the quality and safety of care transitions

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.

WP4 - Developing the intervention 'Your Care Needs You'

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:

1) medicines;

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.

Click on the image below to see a visual summary of our intervention development work.

WP5 - Feasibility testing of the ‘Your Care Needs You’ Intervention

Status – Active (May 2019 – March 2020)

We are currently testing out trial procedures within 3 NHS Hospital Trusts across 9 wards.   We are over half way through recruitment which is due to be completed by the end of March 2020. A protocol paper and findings paper will be published from this work.

WP6 - A cluster randomised controlled trial of the effectiveness and cost-effectiveness of PACT and parallel process evaluation

Status – due to start May 2020

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.

Publications and outputs

Title Output Work package Link
 

Going home from hospital – Patient experiences (patients and carers findings)

 

 Leaflet  WP1  

Click here

 

A qualitative study exploring the experience and

involvement of older people moving from hospital to home

 

Poster

 

WP1

 

Click here

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

 

Click here

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

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

Further information

Click here for information on our PACT Patient and Public Involvement Panel.

For further information contact Professor Rebecca Lawton, Principal Investigator R.J.Lawton@leeds.ac.uk or Dr Jenni Murray, Programme Manager jenni.murray@bthft.nhs.uk 01274 383667

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.