Emergency department Not Applicable
Conditions
Interventions
A mixed methods study programme of frequent users of the emergency department (ED) and the services provided for this group of patients. The study is not a trial but a naturalistic evaluation of curre
Sponsors
University of Leeds
Eligibility
Sex/Gender
All
Inclusion criteria
Inclusion criteria: NHS or third-sector staff: 1. Aged 18 years or over 2. Has been involved in some capacity with a frequent user/high-intensity service, either directly work in the service, or make referrals to the service, have patients who have used the service or have some strategic connection to the service 3. Mental capacity to provide full and informed consent Service users: 1. Aged 18 years or over 2. Has used urgent and emergency care five or more times in the 12 months prior to receiving an assessment or treatment from a frequent user service. 3. Has been assessed or received an intervention from a frequent user service 4. Mental capacity to provide full and informed consent
Exclusion criteria
Exclusion criteria: NHS or third-sector staff: Have no working/managerial/strategic relationship with a frequent user/high-intensity service Service users: 1. Has had no contact with a frequent user or high-intensity service 2. Lacking the capacity to comply with study requirements 3. Considered by a clinician as currently unsuitable to enter a research study (e.g. too physically unwell, acutely suicidal)
Design outcomes
Primary
| Measure | Time frame |
|---|---|
| Development of an implementation framework of 'ideal' models of service delivery tailored for the different types of frequent user services with a focus on specific interventions for particular subgroups of frequent users. The researchers will use the Consolidated Framework for Implementation Research for systematically examining how interventions are implemented and the TIDieR template as a formal framework for identifying and describing components of the included interventions. Timeline: 31-36 months of the programme. | — |
Secondary
| Measure | Time frame |
|---|---|
| Timeline: 18-30 months of the programme: 1. Individual patient-level analysis of attendances to identify frequent use within years and over multiple years. Examination of how features relating to patients (e.g. age, gender, deprivation) and attendances (e.g. occasional bursts vs more regular in time or reason for attendance) predict further emergency department (ED) use. Time to next ED attendance and time in frequent user status will be modelled using survival trees. These analyses will be developed in the CUREd database which covers the acute services in the Yorkshire and Humber region and then repeated on a national basis using data derived from Hospital Episode Statistics (HES) to investigate the generalizability of findings. HES data will also enable the tracking of ED use across multiple sites. Analysis within CUREd will also focus on pre-hospital urgent and emergency care use (NHS 111, 999) and compare patterns in ED frequent users compared to others. 2. Costs: Using both HES and CUREd datasets, established costing methods will be applied using national reference costs to HES A&E and inpatient healthcare resource groups (HRGs) (including high-cost unbundled HRGs) and exploring micro-costing approaches to more detailed CUREd data to determine the costs associated with frequent use of urgent and emergency care services and the distribution of costs across users and trusts. Comparison will be made between HES and CUREd to consider the consistency of each source. Determining the distribution of frequent attendance at Urgent and Emergency Care and associated costs for the Yorkshire and Humber region (CUREd dataset) and for the whole of England (HES dataset). 3. An interrupted time series analysis of the impact on ED frequent attendance of frequent user services will be conducted with ED attendance as the main outcome measure. For each current service with a clear confirmed start date, a 12-month implementation phase following the date the service was launched, | — |
Countries
United Kingdom
Outcome results
None listed