A protocol for the process evaluation of a multi-centre randomised trial to compare the effectiveness of geriatrician-led admission avoidance hospital at home versus inpatient admission

• Published in: Current controlled trials in cardiovascular medicine Vol. 19; no. 1; p. 569
• Main Authors: Mäkelä, Petra, Godfrey, Mary, Cradduck-Bamford, Andrea, Ellis, Graham, Shepperd, Sasha
• Format: Journal Article
• Language: English
• Published: England BioMed Central Ltd 19.10.2018; BioMed Central; BMC
• Subjects: Admission avoidance; Aged, 80 and over; Analysis; Caregivers; Clinical trials; Comprehensive Geriatric Assessment; Data Analysis; Frailty; Geriatric Assessment; Geriatricians; Geriatrics; Home Care Services; Hospital admission and discharge; Hospital at home; Hospitals; Humans; Inpatients; Interviews; Length of stay; Medical care; Medical personnel; Multicenter Studies as Topic; Older people; Patient Admission; Pharmacists; Practice; Primary care; Process Assessment, Health Care; Process evaluation; Professional ethics; Qualitative Research; Randomized Controlled Trials as Topic; Social workers; Study Protocol; United Kingdom > UK; England; Scotland; Hospital at home; Comprehensive Geriatric Assessment; Admission avoidance; Process evaluation
• ISSN: 1745-6215; 1745-6215
• DOI: 10.1186/s13063-018-2929-4

Attempts to design services to support the delivery of healthcare closer to home have taken various forms as countries respond to an increase in hospital admission rates for older people, who are at risk of hospital-acquired morbidity, prolonged lengths of stay and readmission. Evidence to support the development of these services is limited. We are conducting a process evaluation, alongside a UK multi-site randomised trial, to understand the contexts and practices of implementing geriatrician-led admission avoidance hospital at home services and to explore ways that the intervention might be effective, under what conditions, for whom, and how it differs from inpatient care. We are interviewing patients and their caregivers, from sites that are purposively sampled from participating National Health Service (NHS) trusts across the UK. We are also visiting sites to observe local processes and discuss the establishment and running of services with a range of multidisciplinary staff, managers, commissioners, primary care and social services representatives. We aim to interview approximately 36 patients and their caregivers with experience of hospital at home or inpatient services; 12 at each of three sites. We will use a content analysis approach to explore data across participants, services and sites. This process evaluation will enable evaluation of implementation processes prior to knowing trial outcomes. We encompass domains of reach, delivery, change, context and response to the intervention by patients, their carers, health professionals and the health system. ISRCTN60477865 . Registered on 10 March 2014. Trial sponsor: University of Oxford. Version 3.1, registered on 14 June 2016.