Interventions for assessment and medical care without hospital transfer for older people living with frailty: findings from a formative evaluation

Introduction Medical care in the community as an alternative to hospitalisation is central to the NHS strategy to reduce hospital admissions of older people living with frailty. There is little evidence on how community care is provided and what effect it may be having. We evaluated two different integrated care interventions in the West Midlands, UK, to document their components, how they were implemented, and their uptake. Methods The interventions were studied using qualitative and quantitative data across three work packages. Work Package One: we consulted key informants to understand the interventions as intended. Work Package Two: we conducted interviews with stakeholders to explore how the interventions were being implemented. Work Package Three: we analysed routinely collected data to understand their uptake. We used the information gathered from key informants to develop a description of the models according to the Template for Intervention Description and Replication framework. Quantitative data was analysed using descriptive statistics, while qualitative interview data was analysed using Framework Analysis. Results Despite the lack of a manual or protocol we were able to reconstruct the main elements of each model. One was a Hospital-at-Home service that made extensive use of point-of-care diagnostics. The other provided two telephone services to triage patients to admission or receive care the community; the first service ‘call before you convey’ enabled the West Midlands Ambulance Service to call hospital-based geriatricians for expert input for conveyance decisions, while the second service ‘integrated care coordination’ navigated patients to an ‘Urgent Community Response’ team. Over the 12-month study period the Hospital-at-Home service (model one) cared for 201 patients. However, we have no information on how many people used ‘model two’ because datasets capturing patients that interacted with the ‘call before you convey’ or the ‘integrated care coordination’ did not exist. Conclusions It should be a tenet of good managerial practice that a manual/protocol is produced when interventions/programs are implemented and 2) it is highly desirable for research to be commissioned before interventions are implemented so that a proper prospective evaluation can be put in place.