Bringing the hospital into the home and care home for acute medical illness: Processes of Care in Acute Hospital at Home care models
A fully-funded, part-time Masters by Research is available now under our Acute Care Interfaces theme, based at the University of Warwick. Deadline for applications is Sunday November 12, 2023.
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About the Project
The acute medical care pathway is under increasing pressure, with year on year increases in the number of patients coming into hospitals for acute assessment and treatment. There is no increase in hospital capacity to treat the increasing number of patients with the result that hospital bed occupancy remains at very high levels (which is associated with an increase in harm to patients) and emergency departments have much larger numbers of patients with a resultant long wait for assessment and care. A critical element of acute care delivery is the recognition of frailty and the provision of rapid assessment from a team with frailty expertise which will optimise clinical and functional outcomes for older people.
A recent NIHR randomised trial showed that consultant-led hospital at home models have similar clinical outcomes as hospital admission (with reduced incidence of delirium and progression to institutional care) and is also cost-effective, when compared with the costs of hospital admission. However, little is known about the optimal range of care processes which a Hospital at Home team should deliver – this could include the range of diagnostic tests available at the Point of Care such as blood tests or ultrasound, the range of interventions e.g. fluid, antibiotics, diuretics etc. and the range of monitoring equipment that should be used.
The main objectives are to:
1) Explore the views of clinicians in hospital at home about the ideal range of tests, treatments and monitoring equipment which can be delivered in the home or care home setting.
2) Undertake a focussed ethnography of Hospital at Home services using an enhanced range of technologies across diagnostics, interventions and monitoring to understand barriers and facilitators of usage.
3) Understand patient and carer experience of receiving care in the home or care home which has been supported by diagnostic testing, advanced interventions and/or monitoring.
The findings from the study will contribute to development of the Hospital at Home model of care in the UK and internationally, as well as supporting policy makers within NHS England and the Department of Health and Social Care.
Methodology and techniques to be employed
Study design: A mixed methods study involving surveys, qualitative interviews and focussed ethnography.
Setting: Acute Hospital at Home services in the West and South Midlands.
Participants: Professional interviews: clinicians working within Hospital at Home services in the UK. Patient interviews: patients treated by Acute Hospital at Home services in the West Midlands and South Midlands/Thames Valley.
Outputs: Descriptors of optimal range of processes of care for Hospital at Home services treating adults in the NHS. Descriptors of barriers and facilitators in the use of technologies by Hospital at Home services
Further details
This is an NIHR fully-funded, part time Master’s by Research which is open to applicants who are nurses, midwives, allied health professionals including pharmacists and healthcare scientists, healthcare assistants, carers and working in other health-related occupations.