Title: INFORM: Improving care for people who Frequently call 999: co-production of guidance through an Observational study using Routine linked data and Mixed methods
Funder: Health and Care Research Wales (Welsh Government)

Abstract: Background Risk of mortality and other adverse events is high in people who make frequent calls to the emergency services across the developed world. This group of patients present an operational challenge to providers of emergency ambulance services, and their needs are inadequately met by current service provision. For example, the Welsh Ambulance Service NHS Trust (WAST) responded to 5,532 calls made by approximately 200 people between July and September 2017, costing £70,000 per month. New models of cross-sector care are emerging, but the evidence base related to epidemiology, patient and service provider experience, safety and effectiveness of care for this marginalised and vulnerable patient group is lacking. Current care and service innovation often focuses on efficiency (to reduce calls), rather than patient needs. We propose in this study to better understand patterns and outcomes of frequent calling and to work with stakeholders to co-produce guidance for formal testing in a future evaluation. Aim To co-produce guidance for optimal care for people who frequently call 999 based on previous evidence, epidemiology and stakeholder views and experience Research questions *What does the literature say about people who call 999 frequently, patterns of use, experiences of care and outcomes? *What is the epidemiology of callers who frequently call the 999 emergency ambulance service in Wales? -Caller demographics; casemix -999 service use patterns and responses for people who call frequently (ambulance dispatch; response time; conveyance) -Outcomes – further emergency department contacts, emergency admissions, length of stay and mortality *What are patients’ and care providers’ perspectives on the care of people who call frequently? -Reasons for calling -Experience of service use and service provision -Current ambulance service response models, including follow up and referral to cross-sectoral approaches *What recommendations can be included in the co-produced guidance to improve care for patients who call 999 frequently? Design: A mixed methods study using national linked routine data and qualitative methods in two study sites in Wales (Cardiff and Vale and Abertawe Bro Morgannwg University Health Boards) where different models of care are in place. Plan of investigation: 1.Undertake a scoping review of national and international literature 2.Identify patients who call frequently through WAST and anonymously link to their NHS health data 3.Conduct qualitative Bio-photographic Elicitation interviews with patients (n=34) 4.Conduct focus groups/interviews with care providers in the ambulance service and partner (n=22) 5.Facilitate co-production workshops with stakeholders (n=18) Summary of benefits to the NHS, patients and the public: This proposed research will help NHS Wales to understand the scale and nature of the problem of frequent calling; why it occurs, patterns of use, outcomes and the experience of callers and service providers. Co-produced guidance based on previously published evidence, new epidemiological information and the views and experience of patients and service providers may help to improve care and outcomes. Potentially, the guidance can help to reduce frequent calling (benefit for WAST); improve patient experience and outcomes (benefit for patients); identify opportunities for improvements to health and social care provision more widely (benefit for system).


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