Centre for Health Innovation, Leadership and Learning (CHILL)
Community Rehabilitation and Care Transitions for Elderly people (CIRACT)
Older people represent a significant proportion of patients admitted to hospital as an emergency. Their care, compared to younger patients is much more challenging, their stay in hospital much longer, the risk of hospital acquired problems much higher, and the risk of being re-admitted within 28 days much greater. One service is the traditional hospital based rehabilitation (THB-rehab) service. In the THB-rehab service patients are assessed and managed by the hospital based multidisciplinary team for the duration of their hospital stay and on hospital discharge they are referred to the community rehabilitation service and social service for personal care. The other service is a community in-reach rehabilitation and care transition (CIRACT) service. This is delivered by an occupational therapist, a junior physiotherapist and two assistant practitioners. They provide more intensive hospital rehabilitation, work closely with the patient and their carers while in hospitals and allow a more seamless, integrated discharge back to the home where they follow up the patient.
The over-arching aim of the research is to determine whether CIRACT achieves this by comparing the clinical effectiveness, overall cost and cost-effectiveness of a community in-reach rehabilitation and care transition (CIRACT) service with the usual hospital ward based rehabilitation (THB-rehab) service.
How is CHILL involved?
CHILL led the qualitative work stream to investigate the design, implementation, organisation and experience of the CIRACT, and to develop recommendations for improvement.
The qualitative appraisal involved an ethnographic study of the organisation, delivery and experience of the CIRACT service from the perspective of key stakeholders and patients. This showed that:
- the service was highly regarded by those most involved
- the emergent configuration of the service working across organisational and occupational boundaries was not readily accommodated by aligned established services
- external pressure and system change over-shadowed the implementation of the new service
Principal Investigator: Professor Opinder Sahota, Nottingham University Hospitals
Qualitative team: Professor Justin Waring, Dr. Fiona Marshall, University of Nottingham
Funder: NIHR Health Services and Delivery Research (HS&DR) Programme
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