Title: Who knows best? Older people’s contribution to understanding and preventing avoidable hospital admissions.
Funder: Department of Health (England)

Abstract: Every year, the NHS experiences more than 2 million unplanned admissions for people over 65 (accounting for 68 per cent of hospital emergency bed days and the use of more than 51,000 acute beds at any one time) (Imison et al ., 2012; Poteliakhoff and Thompson, 2011). With an ageing population, a challenging financial context and major structural upheavals throughout the health service, such pressures show no sign of abating – and the NHS is having to find ways of reducing emergency hospital admissions (in situations where care can be provided as effectively elsewhere). In the past, this issue has been researched in terms of formal tools which judge whether or not an admission was ‘appropriate’ – but more detailed approaches are needed to understand the views of different professionals and of older people and their families. As previous pilot work has suggested, the latter are often best placed to take a more holistic view of what has happened to them and identify earlier scope for preventative approaches (see also Lawrie and Battye, 2012 for a rare example of more user-focused research into such issues). One of the reasons why it has proved so difficult to tackle the issue of emergency hospital admissions is that it is so complicated and multi-faceted. In this proposal, we argue that only an equally multi-faceted response will suffice – and that we therefore need to understand scope for prevention in the round. With this in mind, our research will review the formal evidence about the rate and cause of potentially avoidable admissions. However, we will supplement this with original research to explore older people’s experiences of emergency admission and their ideas for more preventative approaches. Where the older people and their families would like to, this will also include consideration of a family/carer perspective. In addition we will work with local health and social care professionals to examine their ideas about the scale and cause of potentially avoidable admissions, and any service developments that could prevent admissions altogether. Overall, the study will include: A review of the literature on the appropriateness of emergency admissions identifying the rate and cause of potentially avoidable admissions and any potential solutions proposed. Interviews to identify clinical and managerial views on actions being taken locally to reduce the number of admissions (20 individuals per site in 2 case study sites). Detailed insights into the cause and experience of admission from older people and their carers (50 people per site in 2 case study sites). Additional information from a lead medic, GP and social worker about whether or not the admission could have be avoided (for each of the older people interviewed above). A focus group with professionals in each site which will comment on vignettes derived from the interviews with older people and develop practical service/policy responses. The research will be overseen by a national sounding board of researchers, professionals, managers and older people’s organisations, who will help us to integrate insights from these different perspectives. We have also included as partners several leading national organisations who will help us share any lessons learnt through a good practice guide that will be sent to all hospitals across England and through a short video on ‘Social Care TV’. The research will also be informed by an older people’s reference group, who will help us design material that is as accessible as possible for older participants and identify key themes emerging from the study.


Research activity codes: 8.1 ORGANISATION AND DELIVERY OF SERVICES
Health categories: GENERIC HEALTH RELEVANCE