Partners at Care Transitions (PACT)

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 observational work we identified several key themes. These were:

• Valuing feeling cared for and supported;
• Loss of autonomy and independence;
• Poor communication;
• Confusion about medicines;
• Difficult discharges (either sudden & unexpected or drawn out and disorientating)
• Lack of receipt in the community;
• Lack of patient and carer involvement.

See the Publications and Outputs section below for all reports and conference presentations relating to this work package.

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.

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 has been used in the main trial (see WP6).

See the Publications and Outputs section below for all reports and conference presentations relating to this work package.

Status – complete

We took the findings from WP1 and WP2 and identified the key activities that patients take on when they return home.  We then co-designed an intervention to help patients and families ‘know more’ and ‘do more’ in hospital to better prepare them for returning home. After conducting a formative evaluation we ended up with an intervention called Your Care Needs you and this includes a patient booklet, short film, and an advice sheet for managing at home.

See the Publications and Outputs section below for all reports and conference presentations relating to this work package.

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 we are 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.

See the Publications and Outputs section below for all reports and conference presentations relating to this work package.

Status – complete

11 hospital Trusts and 39 wards took part in the trial.  We recruited 4861 patients into a dataset that will inform our primary outcome (unplanned hospital readmissions) and over 600 patients took part in follow-up questionnaires asking them about their preparedness for going home, post discharge adverse events, quality of life, use of services and views on the Your Care Needs You intervention. We are currently analysing the results so watch this space…

Publications

Hardicre, N. K, (2020).  SAGE Case Study – ‘Going Along’ or ‘Sitting Around With? Go-Along Interviews with Older People in Hospital to Understand Experiences at Transitions of Care [online] SAGE Research Methods Cases. https://dx.doi.org/10.4135/9781529740325

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, https://bmjopen.bmj.com/content/7/11/e018054

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. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6803411/

Hardicre, N. K., et al. (2021). Doing involvement: A qualitative study exploring the ‘work’ of involvement enacted by older people and their carers during transition from hospital to home. https://doi.org/10.1111/hex.13327

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. https://bmjopen.bmj.com/content/8/9/e022468

Hardicre, N. K., et al. (2017). Partners at Care Transitions? A qualitative study exploring the experience and involvement of older people moving from hospital to home. https://bmjopen.bmj.com/content/7/11/e018054

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. https://doi.org/10.1186/s12913-019-4306-8

Baxter, R., Murray, J., O’Hara, J.K. et al. (2020) Improving patient experience and safety at transitions of care through the Your Care Needs You (YCNY) intervention: a study protocol for a cluster randomised controlled feasibility trial. Pilot Feasibility Stud 6, 123 (2020). https://doi.org/10.1186/s40814-020-00655-5

O’Hara, J et al (2018) Scaffolding our systems? Patients and families “reaching in” as a source of healthcare resilience. BMJ Qual Saf https://qualitysafety.bmj.com/content/28/1/3

O’Hara J, Cranfield C, Aase K. (2019) Patient and family perspective in resilient healthcare studies: A question of morality or logic. Safety Science 2019;120:99-106 https://doi.org/10.1016/j.ssci.2019.06.024

O’Hara J, Baxter R, Hardicre N.  (2020) Handing over to the patient’: A FRAM analysis of transitional care combining multiple stakeholder perspectives https://DOI:10.1016/j.apergo.2020.103060

Shannon, R et al (2022) A qualitative formative evaluation of a patient facing intervention to improve care transitions for older people moving from hospital to home. https://doi.org/10.1111/hex.13560

Murray J, Baxter R, Lawton R, Hardicre N, Shannon R, Langley J, Partridge R, Moore S, O’Hara JK. Unpacking the Cinderella black box of complex intervention development through the Partners at Care Transitions (PACT) programme of research. Health Expect. 2023 Aug;26(4):1478-1490. https://doi.org/10.1111/hex.13682

Mills, T., Shannon, R., O’Hara, J., Lawton, R., & Sheard, L. (2022). Development of a ‘real-world’ logic model through testing the feasibility of a complex healthcare intervention: the challenge of reconciling scalability and context-sensitivity. Evaluation, 28(1), 113–131. https://doi.org/10.1177/13563890211068869

Moore, S, Schofield, J (2022) Transitions of care: Helping older people to return home from hospital. Nursing Times [online]; 118; 10. https://www.nursingtimes.net/clinical-archive/patient-safety/transitions-of-care-helping-older-people-to-return-home-from-hospital-05-09-2022/

Baxter, R., Murray, J., Cockayne, S. et al. Improving the safety and experience of transitions from hospital to home: a cluster randomised controlled feasibility trial of the ‘Your Care Needs You’ intervention versus usual care. Pilot Feasibility Stud 8, 222 (2022). https://doi.org/10.1186/s40814-022-01180-3

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). https://doi.org/10.1186/s12913-020-05641-4

Oikonomou, E., Page, B., Lawton, R. et al. Validation of the Partners at Care Transitions Measure (PACT-M): assessing the quality and safety of care transitions for older people in the UK. BMC Health Serv Res 20, 608 (2020). https://doi.org/10.1186/s12913-020-05369-1

Outputs

Patient and Public Summary

How to promote safety during transitions of care: A guide for CCGs and NHS Hospital Trusts.’ Output: Guide

Partners at Care Transitions? A qualitative study exploring the experience and involvement of older people moving from hospital to home

A qualitative study exploring the experience and involvement of older people moving from hospital to home

A feasibility trial of the Partners At Care Transitions (PACT) intervention