Stroke Circulatory System Stroke, not specified as haemorrhage or infarction
Conditions
Interventions
This study will follow an explanatory multiple case design to investigate qualitatively three purposively selected ESD teams from East Midlands, East of England and North of England respectively (reg
Sponsors
University of Nottingham
Eligibility
Sex/Gender
All
Inclusion criteria
Inclusion criteria: 1. Staff participants: 1.1. Adults (over the age of 18 years) 1.2. NHS staff participants involved in delivery of the ESD service (i.e. consultants, occupational therapists, rehabilitation assistants, physiotherapists, social workers, nursing staff, psychologists and administrators) 1.3. Stroke service commissioners (i.e. members of a Clinical Commissioning Group (CCG) involved in the commissioning of ESD services) 2. Patient participants: 2.1. All stroke patients who are admitted to ESD services and fit the eligibility criteria used by the hospital and community-based staff. Eligibility criteria are likely to include the patient wishing to return home, that they are medically stable and that they can transfer independently or with the assistance of one person. It is highly unlikely that stroke patients with mental capacity issues and those unable to consent, will be eligible or referred to an ESD service. 2.2. Having sustained first or recurrent stroke 2.3. Medically stable 2.4. Ability to give informed consent 2.5. Aged between 16 and 100 years old 2.6. In the services’ caseload at the time of recruitment
Exclusion criteria
Exclusion criteria: 1. Staff participants: 1.1. Communication problems (e.g.aphasia) that prevents participation in the interviews. 2. Patient participants: 2.1. Stroke patients who are not eligible for Early Supported Discharge (ESD) 2.2. Patients who do not have adequate understanding of the English language to participate in the interviews (translators may not be available in community-based services)
Design outcomes
Primary
| Measure | Time frame |
|---|---|
| Work package 1: The selection of outcome measures reflects both evidence based metrics, as defined in national clinical guidelines, and outcomes that were used to measure effectiveness of ESD in original clinical trials. These include: a) length of hospital stay, b) responsiveness of the service, c) amount of rehabilitation delivered and d) changes in patient dependency as measured by the Modified Rankin Scale recorded before stroke, at hospital discharge and discharge from the ESD service. Data for these outcomes are routinely collected by stroke services and will be obtained by gaining access to historical prospective SSNAP clinical audit data from hospital and community providers across the East Midlands, West Midlands, East of England and Northern England. Work package 2: To assess perceived effectiveness and contextual influences on implementation, qualitative data will be collected through: 1. Staff interviews: Semi-structured one-to-one interviews will be conducted with up to ten NHS staff informants at senior management, service lead and commissioning levels at each ESD site (up to 48 in total). Participants will be identified through collaboration with the national audit team and clinical network cardiovascular leads and stroke clinical leads operating in each region. Two group interview sessions will also be conducted at each of the six sites with a representative cross-section of disciplines included in the ESD team (physicians, therapists, nurses, rehabilitation assistants, administrators). 2. Stroke survivor interviews: Interviews with 5 purposively selected ESD patients per site (30 patients in total) will also be conducted. Patients will be recruited by the ESD teams in consultation with the research team. Purposive sampling will allow to ensure the sample includes patients with a variety of experiences. | — |
Secondary
| Measure | Time frame |
|---|---|
| Cost consequence analysis will be conducted to relate measures of effectiveness of different ESD models with estimated costs of service provision | — |
Countries
England, United Kingdom
Outcome results
None listed