Title: GP Management After Transition Events (GP-MATE) - Developing an intervention to assist older patients’ communication with their GP practice after discharge from hospital in order to improve patient safety
Funder: Department of Health and Social Care

Abstract: Title: GP Management After Transition Events (GP-MATE) - Developing an intervention to assist older patients' communication with their GP practice after discharge from hospital in order to improve patient safety Research questions: i) What is the optimal design for a communication tool to assist older patients/their carers to communicate with general practice after discharge from hospital?ii) How will this communication tool improve patient safety outcomes and patient experience? Background: 5.2 million patients aged over 75 are discharged from hospital each year in England. Many will experience a preventable adverse event associated with their discharge, including over 400,000 who are potentially harmed as a direct result of how general practice manages their discharge summary communication. Such harm is generally of moderate severity, but sometimes leads to readmission, end-organ damage and death. Communication with patients and carers is key to successful discharge from hospital, but their interaction with their primary care providers after discharge is poorly researched and few tools exist to assist this process. Aims: To co-produce an intervention to assist older patients/carers to better communicate with their GP practice after discharge from hospital (GP-MATE) in order to improve patient safety outcomes for older patients. Objectives: To prepare a 'patient experiences' video and other materials for use in the Experience Based Co-Design (EBCD) process. To co-produce with patients/carers and stakeholders an intervention (GP-MATE and a learning set to educate primary care providers) on safer post-discharge care for older patients. To undertake a feasibility study of GP-MATE in eight West-Midlands general practices to test acceptability and usability for patients/carers and primary care staff. Informed by workshops with primary and secondary care stakeholders, prepare study protocol for definitive study of costs and clinical effectiveness of GP-MATE Methods and Timelines for delivery: Four-year mixed-methods study. In year one (objective one) a video of patient experiences will be created along with other materials to inform the co-production process. In year two (objective two), co-production will be undertaken with patients/carers and GP stakeholders in diverse settings across three counties to create the communication tool. In year three, (objective three) a mixed-methods feasibility study of deploying GP-MATE will be conducted in eight West-Midlands practices involving ~300 patient records, 24 patient/carer interviews and 24 staff interviews. Objective four will focus on synthesis of findings, dissemination and preparation for a definitive trial of cost and clinical effectiveness of GP-MATE after conducting workshops with a variety of stakeholders. Anticipated impact and dissemination: A PPI-E specific dissemination plan will promote public engagement with the findings. Academic dissemination will include papers in high impact journals and presentations at GP and patient safety conferences to enhance acceptance of GP-MATE by healthcare professionals and academics. Working with the RCGP, HealthWatch, U3A and AgeUK is anticipated to promote adoption of GP-MATE into national standard care. Once adopted into standard practice, the anticipated impact of GP-MATE will be: to improve patients/carers self-efficacy and satisfaction; reduce patient safety incidents; prevent readmissions and gain recognition/funding for peri-discharge care in general practice.

Lay abstract: Title: GP Management After Transition Events (GP-MATE) - Developing an intervention to assist older patients' communication with their GP practice after discharge from hospital in order to improve patient safety Aim: To make and test an approach ('GP-MATE') to assist older patients and their carers to discuss with their GP practice their care after coming home from hospital. This is to make care safer and prevent mistakes from occurring. Background: Being discharged from hospital carries risks. Older people who often have complex ongoing health needs are most at risk, and with over 5 million patients aged 75 or older coming home from English hospitals each year this is an increasingly serious issue. For each patient a letter is sent from the hospital to their GP. This should explain the care that has been provided, and what needs to be done in the weeks and months ahead. There are problems with how many of these letters are managed, and one in thirteen older patients are harmed as a result (over 400,000 patients in England each year). Harms are usually mild, but sometimes include; having to go back into hospital, organ damage and even early death. Older patients and their carers have a key role to play in preventing these errors and harms. GP-MATE will be designed to help them take a more active role in their general practice care after coming home from hospital. It will help empower them to do so with greater success. Design and Methods used: This 4-year study uses a method called 'Experienced Based Co Design', so allowing patients and carers to be closely involved in all stages of developing GP-MATE. Year 1 - The first step is to carefully create a film of patients' experiences following hospital discharge that depicts the strengths and weaknesses of current practice. Year 2 - To design GP-MATE, three groups of older patients and GP staff across the country will meet repeatedly. The film will be used to break down barriers within the groups that can prevent working together effectively. We will provide examples of approaches that have been used in other countries to help patients discuss their care with healthcare staff, and work with the groups to create GP-MATE. Year 3 - We will study the use of GP-MATE at eight general practices. We will talk to 24 patients and their carers and 24 staff to gather their views. Everyone who uses GP-MATE will be sent a survey, and we will look at the records of around 300 patients for evidence of its impact. Year 4 - We will draw on our findings to perfect GP-MATE's design to make it ready for national use and future research aimed at showing how it leads to better outcomes for patients, health services and society as a whole. Patient and Public Involvement: This study is led by patients and carers who will be involved at all stages of the study through a PPI-E panel. This will help to ensure GP-MATE is both useful to and useable by, patients and carers. Two patient events have explored the importance of this topic and informed the research design. Dissemination: We will share the research findings with health service and academic groups through publications, reports and presentations. Results will be made public to patients via our unit PPI-E newsletter and our Unit webpage. Wider impact will come from working with University, NHS and charities' (e.g. AgeUK) media teams. NHS publications for patients will be approached in both hospitals and general practice. Collaborating with HealthWatch and HealthTalk will increase the impact of our findings.

Research activity codes: 7.1 INDIVIDUAL CARE NEEDS
Health categories: GENERIC HEALTH RELEVANCE