Title: Acute hospital care for frail older people
Funder: Department of Health (England)

Abstract: We will describe existing models of care and develop and validate tools to deliver CGA on a hospital wide basis.Research questions The main questions addressed by this proposed programme of research are: • How is CGA defined and recognised? • How and in what forms CGA is currently organised and delivered in the UK?• Who receives CGA and can we identify who benefits most?• How can we develop tools to assist delivery of CGA on a hospital wide basis?Aims and objectives AimThe overarching aim is:• To provide high quality evidence to support the delivery of CGA on a hospital wide basis.ObjectivesThe objectives are to systematically:• Define CGA its processes outcomes and costs• Identify the processes outcomes and costs of CGA in existing hospital settings in the UK• Identify the characteristics of the recipients and beneficiaries of CGA in existing hospital settings in the UK• Use this new knowledge to develop tools which will assist in the implementation of CGA on a hospital wide basisThese objectives will be achieved in 4 workstreams (1-4 below). Each of the workstreams feeds forward to support subsequent workstreams There will also be overarching management and PPI workstreams (5 and 6 below) which will interact with all the other workstreams The aims of each of the workstreams and the methods they will use to achieve these aims are outlined below.Workstream 1. Defining CGAAim: Summarise current research and service evidence for Comprehensive GeriatricMethods: 1.1. A rapid review of literature reviews about CGAWorkstream 2. Identify CGAAim: Identify and provide a description of current provision in the UKMethods: 2.1. A survey of current provision of CGA in the UK 2.2. The creation of tools to understand need for CGAWorkstream 3: Characterise beneficiariesAim: Identify who gets and who benefits from CGA in hospitalMethods:3.1. Assess the relationship between frailty markers and longer term patient outcomes and service costs3.2. Test Hospital Episode Statistic based proxies for markers of frailty3.3. Estimate the potential impact of CGA on acute hospital careWorkstream 4. Produce disseminate and evaluate implementation toolsAim: Produce implementation toolkits to disseminate best practice in CGAMethods: 4.1. Use outputs of workstreams 1-3 to define and then validate clinically and cost-effective models of care4.2. Develop implementation strategies and tools to help the commissioning and delivery of CGA on a hospital wide basisWorkstream 5: Embedded PPI (input to all workstreams)Aim: Ensure appropriate involvement of public and patients in proposed researchMethods:5.1. Support a dedicated PPI workstream with an appointed lead to:a. Manage coordinate and support PPI recruitment and activities in each research workstream (workstreams 1-5)b. Provide PPI training and support to researchers and volunteersc. Evaluate and report on experiences and impacts of PPId. Set up and manage a web-based PPI information and communication network report on PPI activities to the management workstream (workstream 7)5.2. Meet with reimburse and cover expenses of PPI volunteers across all workstreams5.3. Ensure the inclusion of PPI within the main duties and responsibilities of a dedicated individual in every workstream5.4. Meet the costs of setting up and maintaining a web-based networkWorkstream 6: Overarching management packageThe management arrangements will comprise:6.1 A board made up of members of the NIHR Age & Ageing specialty group with PPI lead and representative chaired by Parker6.2 An executive made up of the workstream leads and the programme manager led by Conroy6.3 An external steering group which will provide oversight and act as data monitoring and ethics committee as required.


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