Title: Patient involvement in improving the evidence base on inpatient care
Funder: Department of Health (England)

Abstract: The main aim of the programme is to introduce the patients’ perspective to health service evaluation in order that the services are more acceptable and therefore likely to produce the maximum benefit. The programme will also provide a practical contribution to both methods and measurement of service change. We will: 1. develop new methods of research and new measures that capture the acceptability as well as the experience of mental health interventions 2. apply these methods and measures to evaluate innovatory health and social care interventions to determine if it they are effective, cost-effective and acceptable to service users The focus of the programme is on a mental health service which is known to have distinct problems – inpatient acute care. Several reports from the Department of Health and from service user groups have suggested that current ward environments have acute problems resulting from increased severity of symptoms and behaviour problems and are compounded by a high staff turnover who are reported to feel deskilled and de-motivated. This is a service which has been highlighted as needing urgent consideration. The programme contains 4 linked work packages, two methodological and two service developments. Work packages (WP) 1 & 2 are focussed on areas of methodological uncertainty which are essential to the development of a good practice evidence base and cost effective services. The outputs from both packages will be of importance to the appraisal of mental health services but will also be of direct use in WP 3&4 where they will be field tested. WP 1 is focussed on developing a participatory research method which will produce a service user measure of perceptions of inpatient care. Unlike most assessments of satisfaction this measure will not only use the language of service users but will assess domains of care as defined by service users rather than researchers. This participatory methodology has been pioneered in the Service User Research Enterprise (SURE) at the Institute of Psychiatry. The same method will be used to develop a measure of staff views and in this study a nursing researcher will be involved. Both measures will be used in WP 3&4 and their results not only compared to the rate of change in inpatient services but also to “hard” traditional outcomes such as length of stay. WP 2 focuses on health economic evaluations and the difficulty of assessing the cost-effectiveness of a service when there is a paucity of background data or the data are context dependent. This work package will develop a process for systematic reviews of studies containing data on resource use (not necessarily costs) alongside clinical data. This will concentrate on the two areas investigated in WP 3&4. Decision models will then be developed using these data to estimate the cost-effectiveness of existing and innovative inpatient interventions. The models map the pathways through care and the outcomes experienced following different interventions. Costs are subsequently attached to key events along these pathways. Finally this work package will develop a new measure of economic data collection to encompass the details of the inpatient care package. WP 3 & 4 will investigate two new service developments for inpatient care. Data from both evaluations will provide not only the field trial for the new assessments from WP1&2 but will provide data for effect size calculations for larger multi-centre studies. The aim of the service development in WP3 is to enrich the therapeutic environment, providing staff with new skills in individual and group based treatments that can be carried out on the ward. The main outcome is the perceptions of staff and patients but other outcomes such as staff burnout, the ward atmosphere and cost-effectiveness will also be measured The evaluation will be a waiting list cluster randomised control design with assessments at baseline, six months, 12 months and 18 months. Qualitative data will also be collected to ensure that we have captured all the beneficial and untoward effects. WP 4 is a comparison between two models of “triage” wards in which patients are assessed and discharged or moved to longer term care within 7 days of admission. The two service models both have the likelihood of reducing the number of bed days and allowing more focussed problem oriented care to take place. The assessment will take place over 18 months to track both the use, the effects on other wards in the service system and, in particular, the way the model has an impact on service users and staff. The expected outcomes will allow an understanding of the impact of the wards on the whole service system. Therefore staff and patient assessments will not only be collected for those who experience the triage but also staff and patients in other parts of the borough inpatient services. Patient and staff level data will be collected following discharge from the triage system.


Research activity codes: 8.1 ORGANISATION AND DELIVERY OF SERVICES;8.2 HEALTH AND WELFARE ECONOMICS
Health categories: MENTAL HEALTH