Title: UK evaluation of NHS support post-hospitalisation for COVID19 to inform service development and achieve holistic, integrated, equitable and cost-effective services
Funder: Department of Health and Social Care

Abstract: Research question How has NHS support for patients post-hospitalisation for COVD19 been organised across the two waves of the pandemic and how can services be further developed to achieve holistic, integrated, equitable and cost-effective services? Background Understanding how to optimise NHS support for individuals post-COVID19 infection to maximise quality of life and deliver services which are cost-effective is critical to personalised, high quality, value for money care. In particular, patients whose infection initially required hospitalisation are likely to experience a greater proportion of burden from so-called long-COVID and therefore require more follow-up care and services. The Post-HOSPitalisation COVID19 (PHOSP-COVID) study aims to recruit 10,000 patients across all four nations of the United Kingdom (Tier 1) with more detailed data collected on 3,000 participants (Tier 2) including health service resource use, productivity and quality of life impacts at 3-6, and 12 months. The study was funded in July 2020 and has already recruited 1,000 patients to Tier 2 (admitted Feb &ndash; Aug 2020) with their 3-6 month post-discharge visit completed by end Nov 2020. The study has received a six-month extension to enable recruitment of patients discharged in wave 2 from Dec 2020 until end March 2021. Aims and Objectives We will utilise the PHOSP-COVID platform to identify how patterns of care post-hospitalisation have evolved through the pandemic from the first wave (Mar-Jul 2020) through the second wave (Nov 2020 onwards). Using a mix of qualitative and quantitative methods will enable us to identify the best performing health care pathways in terms of the extent to which they provide holistic, integrated, equitable and cost-effective care for patients discharged from hospital after COVID19 infection. Methods Activities are organised into five work packages: WP1) Surveys of the healthcare services provided to patients after hospital discharge at different NHS trusts for the first wave and second waves with classification into a typology of service delivery pathways. WP2) Qualitative interviews with patients, healthcare professionals, managers and commissioners with the aim to understand the different types of service that have been provided in different parts of the country. WP3) Analysis of the health-related quality of life that patients report at 3-6 months and 1 year after hospital discharge. Analysis of health service costs incurred and productivity changes of patients. WP4) Bringing the previous work package results together to inform the modelling of cost-effectiveness of different service delivery pathways, including consderations of equity of services provided in different parts of the country and to different types of patient. WP5) Dissemination to and engagement with stakeholders through regular meetings with patients, healthcare commissioners, providers such as NHS England, and relevant professional bodies. PPI representatives will be involved at every stage of the study and have been actively involved in this proposal. Timelines for delivery The bulk of the work will be completed within 12 months with and additional 3 months added as contingency and to allow for the final updating of the full one-year follow-up of PHOSP-COVID data collection for wave 2 of the pandemic.

Lay abstract: There are reports by patients and clinicians of prolonged symptoms and significant health issues after coronavirus infection (COVID19). For the first wave of COVID19 there was no nationally funded clinical follow-up service for patients after leaving hospital. However, NHS England has now announced funding for follow-up clinics, but current guidance on what is to be included in these clinics is based on expert opinion only. A large funded follow-up study of adults discharged from hospital after COVID19 (PHOSP-COVID) includes 58 hospital sites with a wide variety of clinical follow-up services. However there is no funding to evaluate the long term changes to health services within the PHOSP-COVID study. We want to help inform person-centred and joined-up health care pathways for patients following COVID19. We plan several research activities using the sites and patients already involved in the PHOSP-COVID study. 1) We will complete surveys of the healthcare services provided to patients after hospital discharge at different NHS trusts for the first wave and the current situation. 2) We will conduct interviews with patients, healthcare professionals, managers and commissioners. We will focus on the patient experience of those services. We aim to understand the different types of service that have been provided to different patients in different parts of the country. 3) We will measure the health-related quality of life that patients report at 3-6 months and 1 year after hospital discharge. This patient data is collected through PHOSP-COVID. We will also measure the costs to deliver each type of service including drug treatments and non-drug services such as rehabilitation and mental health care. 4) We will estimate the value for money of the services. This will bring together the work above on patient and professional experience, and health service costs. We will use this information to look at issues of fairness in terms of services provided in different parts of the country and to different types of patient (including ethnicity, socioeconomic status and existing health issues such as obesity). 5) We will hold regular meetings with patients, healthcare commissioners, providers such as NHS England, and relevant professional bodies. We want to ensure that the research results get used to guide healthcare policy, quickly bringing benefits to all relevant patients. Patient representatives will be involved at every stage of the study and have been actively involved in this proposal. Their role will include advising on: patient-facing material, recruitment strategies to ensure diversity, our interview schedules, our interpretation of the interviews, and any patient or lay-facing broadcasting or publication of the results. We have support from directors of NHS England and the British Thoracic Society for this proposal. We have direct links to share our findings to NHS England Long-Covid Taskforce.

Research activity codes: 8.1 ORGANISATION AND DELIVERY OF SERVICES
Health categories: INFECTION