Creating a lOgic model, Research questions and methods to Evaluate community-based Urgent and Emergency Care services (CORE-UEC)

Funding

NHS Bristol, North Somerset and South Gloucestershire ICB Research Capability Funding.

What is the problem?

An important NHS policy is to provide more healthcare in local communities, take pressure off hospitals and get people the right help when they need it. Understanding how to do this is an important area of research for the Department of Health and Social Care.

Commissioners (who plan local services) are under pressure to respond quickly and introduce new ways of delivering care. They are investing in community-based urgent and emergency care (UEC), including Urgent Community Response services, Virtual Wards, Hospital at Home and interventions for specific conditions (e.g., breathing problems, falls).

However, services are often introduced, changed or stopped without understanding how well they work, whether they offer good value for money, or how they affect the wider system. This makes it difficult to decide how to organise local services, staff and resources.

There is no clear and standard way of judging how well services work. They are often assessed on different outcomes and cannot easily be compared. It is also important to check how services work together in the complex system.

We plan to develop a guide (evaluation framework) for decision-making to help commissioners use limited resources to make the biggest difference for patients.

Describe the work to be undertaken for the RCF

This project will develop a simple map (logic model) showing how services are expected to work, what resources they need, what activities they deliver, how they work within the wider system, and what outcomes are expected. This will support decisions about community-based UEC services. We will follow the stages below.

We will review academic research and reports from healthcare organisations to understand how decisions are made about UEC services.

We will speak with commissioners and service leaders to understand the challenges when planning and delivering care. We will involve patients and the public, particularly those who have the greatest health needs or are most at risk of missing out on healthcare, to understand what matters to them, and difficulties they face accessing care.

We will bring these groups together in workshops to agree the map to be used for the NIHR project planning, and identify key research questions, outcomes, and ideas for how the project should be carried out.

We will explore what data is available and whether it could be used to measure outcomes.

This work will support an NIHR funding application to develop a guide (evaluation framework) for commissioners to understand how well community-based UEC services are working.

Describe the work to be undertaken for the intended NIHR funded project

This project will develop and test a guide (evaluation framework) to help understand how well community-based UEC services are working.
We will describe the different types of community-based UEC services, which vary widely across local and regional areas. We will then review existing research to understand what is known about how well they work (e.g., referral criteria, access requirements, patient outcomes, costs, and when and why these services work).

Next, we will work with commissioners, staff managing and delivering services, patients and the public, to agree what outcomes matter most when deciding whether these services work well. This will help create a standard set of measures that commissioners can select from according to local needs, which can be used consistently but be adapted to different areas.

We will use data to explore whether changes in hospital use are directly linked to community UEC service use or influenced by other factors.

We will test how the guide can be applied in real-world settings, to ensure it is practical and useful, helping commissioners make the best use of limited resources.

Who is leading the research?

This research is led by Dr Anna Blackwell, Research Fellow at the School of Health and Social Wellbeing, University of the West of England, Bristol (UWE).

Further information

For more information or to get involved with this project, please email bnssg.research@nhs.net