Plain English Summary
Background and study aims
Going home from hospital can sometimes be a tricky period for people, particularly older people who may have more health problems. This can be made worse when people don’t understand what needs to be done to manage their health. For example, they may not understand their medicines or they may have lost the confidence to move about in their homes because they didn’t move about much when in hospital. Sometimes this leads to unnecessary hospital readmissions. Patients who are more involved in their care in hospital do better when they get home. Researchers have designed an approach called ‘Your Care Needs You!’ which includes a patient booklet, a short film and an enhanced discharge letter. These aim to encourage patients to ‘know more’ and ‘do more’ in hospital so that they are better prepared to manage at home. The study aims to find out if the ‘Your Care Needs You!’ approach reduces hospital readmissions and improved the quality and safety of the transition from hospital to home for older people.
Who can participate?
Patients aged 75 and over who have stayed for at least one night on a participating ward and are going to be discharged to their own home or that of a relative’s
What does the study involve?
The research will take place within 40 wards (across 8 acute NHS Trusts) over a 12-month period. In total, 20 wards are randomly allocated to deliver the ‘Your Care Needs You’intervention and 20 wards deliver care as usual. On the wards that have been selected to use ‘Your Care Needs You’, all patients can have the booklet, see the film and have an enhanced discharge letter. The researchers compare outcomes (such as hospital readmissions or experience of transition to home) for people who receive ‘Your Care Needs You!’ with those who don’t. The evaluation will involve taking informed consent from patients and then asking them to complete some questionnaires by post or with telephone support. There will be three questionnaires, one at around 7 days after discharge, one at 30 days and one at 90 days. The researchers will also ask some patients to take part in an interview to ask them about their experience of the approach.
What are the possible benefits and risks of participating?
There will be no direct benefits for participants because they will only be consenting to complete questionnaires. Patients on the wards selected to give out ‘Your Care Needs You!’ will get the booklet and film etc regardless of whether they decide to take part in the research evaluation. The benefits to taking part in the evaluation might actually be for patients in the future because by taking part in the research the researchers will get data that will tell them if they have improved the patient experience. There are no known risks to taking part in the evaluation.
Where is the study run from?
The study will be run from the Yorkshire Quality and Safety Research Group based in Bradford. The team will be supported by the York Trials Unit. The study will include up to nine NHS Hospital Trusts from the Yorkshire region and between 40 and 50 wards within these Trusts.
1. Hull And East Yorkshire Hospitals NHS Trust
2. York Teaching Hospital NHS Foundation Trust
3. Calderdale and Huddersfield NHS Foundation Trust
4. Barnsley Hospital NHS Foundation Trust
5. Bradford Teaching Hospitals NHS Foundation Trust
6. Doncaster And Bassetlaw Teaching Hospitals NHS Foundation Trust
7. Harrogate And District NHS Foundation Trust
8. Leeds Teaching Hospitals NHS Trust
When is the study starting and how long is it expected to run for?
August 2019 to March 2022
Who is funding the study?
National Institute for Health Research (NIHR) (UK)
Who is the main contact?
Dr Jenni Murray
jenni.murray@bthft.nhs.uk
Trial website
https://yqsr.org/our-research-programmes/partners-at-care-transitions-pa
Contact information
Type
Scientific
Primary contact
Dr Jenni Murray
ORCID ID
http://orcid.org/0000-0003-0563-0020
Contact details
Research Programme Manager
PACT Research Programme
Yorkshire Quality & Safety Research Group & Patient Safety Translational Research Centre
Bradford Institute for Health Research
Temple Bank House
Duckworth Lane
Bradford
BD9 6RJ
United Kingdom
+44 (0)1274 383667
jenni.murray@bthft.nhs.uk
Type
Scientific
Additional contact
Prof Rebecca Lawton
ORCID ID
Contact details
Yorkshire Quality and Safety Group
Bradford Institute for Health Research
Bradford Royal Infirmary
Duckworth Lane
Bradford
BD9 6RJ
United Kingdom
+44 (0)1274 383465
R.J.Lawton@leeds.ac.uk
Additional identifiers
EudraCT number
Nil known
ClinicalTrials.gov number
Nil known
Protocol/serial number
CPMS 44559, IRAS 277060
Study information
Scientific title
A cluster randomised controlled trial to assess the effectiveness and cost-effectiveness of the ‘Your Care Needs You!’ intervention to improve safety and experience of care transitions
Acronym
PACT
Study hypothesis
Transitions of care from hospital to home can be risky, especially for older people with multiple health conditions. Previous research has suggested that the post-discharge period may be improved by better involving patients and families in their care. This study forms part of a programme of research which aims to develop an intervention to improve the safety and experience of transitions from hospital to home for people aged 75 years and over. In this study, a cluster Randomised Control Trial will be conducted to assess the effectiveness of, cost-effectiveness of, and fidelity to the Your Care Needs You! (YCNY) intervention.
Ethics approval
Current ethics approval as of 07/08/2020:
Approved 31/01/2020, amendment 1 approved 27/04/20202, North East – Newcastle and North Tyneside 2 REC (NHSBT Newcastle Blood Donor Centre, Holland Dr, Newcastle upon Tyne NE2 4NQ, UK; Tel: +44 (0)207 1048091, +44 (0)207 104 8222; Email: nrescommittee.northeast-newcastleandnorthtyneside2@nhs.net), REC ref: 20/NE/0020
Previous ethics approval:
Approved 31/01/2020, North East – Newcastle and North Tyneside 2 REC (NHSBT Newcastle Blood Donor Centre, Holland Dr, Newcastle upon Tyne NE2 4NQ, UK; Tel: +44 (0)207 1048091, +44 (0)207 104 8222; Email: nrescommittee.northeast-newcastleandnorthtyneside2@nhs.net), REC ref: 20/NE/0020
Study design
Randomised; Both; Design type: Process of Care, Complex Intervention, Qualitative
Primary study design
Interventional
Secondary study design
Randomised controlled trial
Trial setting
Hospitals
Trial type
Treatment
Patient information sheet
See additional files
Condition
Care transitions
Intervention
Current interventions as of 07/08/2020:
The research will take place within 40 wards (across 8 acute NHS Trusts) over a 12 month period. In total, 20 wards will deliver the intervention and 20 wards will deliver care as usual. A minimum of 1000 patients will provide informed consent to complete a questionnaire at three timepoints post-discharge and for routine data about their care to be collected from medical records. Data from the questionnaires will be used to measure the effectiveness of the YCNY intervention at improving quality and experience of transitions, quality of life, health care utilisation and 60/90 day unplanned readmission rates (secondary outcomes).
The researchers will also obtain anonymised ward level data for 5,440 patients discharged from participating wards during the period of recruitment to assess the effectiveness of YCNY in reducing 30-day unplanned readmission rates (primary outcome). A process evaluation assessing intervention fidelity and mechanisms of action/contextual factors influencing intervention delivery, will also be conducted. In eight intervention wards, a subset of 24-30 of these patients (with/without carers) will also consent to a qualitative evaluation of the intervention (interviews and observations). Up to 45 staff will be interviewed to gain their views on the intervention and explore contextual factors.
Previous interventions:
The research will take place within 40 wards (across 8 acute NHS Trusts) over a 12 month period. In total, 20 wards will deliver the intervention and 20 wards will deliver care as usual. A minimum of 782 patients will provide informed consent to complete a questionnaire at three timepoints post-discharge and for routine data about their care to be collected from medical records. Data from the questionnaires will be used to measure the effectiveness of the YCNY intervention at improving quality and experience of transitions, quality of life, health care utilisation and 60/90 day unplanned readmission rates (secondary outcomes).
The researchers will also obtain anonymised ward level data for 7,000 patients discharged from participating wards during the period of recruitment to assess the effectiveness of YCNY in reducing 30-day unplanned readmission rates (primary outcome). A process evaluation assessing intervention fidelity and mechanisms of action/contextual factors influencing intervention delivery, will also be conducted. In eight intervention wards, a subset of 24-30 of these patients (with/without carers) will also consent to a qualitative evaluation of the intervention (interviews and observations). Up to 45 staff will be interviewed to gain their views on the intervention and explore contextual factors.
Intervention type
Behavioural
Phase
Drug names
Primary outcome measure
30-day hospital emergency readmissions, measured using routinely collected data on 30 unplanned hospital readmissions
Secondary outcome measures
1. Quality and experience of care transition for patients, measured using Partners at Care Transitions Measure (PACT-M) at 7 days, 30 days and 90 days post discharge
2. Difficulties that patients experienced in hospital that could affect them after discharge, measured using Post Hospital Syndrome questionnaire at 7 days post discharge
3. Quality of life, measured using EuroQol 5-Dimension Health Questionnaire (5 levels) (EQ5D-5L) and Proxy EQ5D-5L at 7 days, 30 days and 90 days post discharge
4. Healthcare resource use measured using unvalidated questions about services used since discharge at 7 days, 30 days and 90 days post discharge
5. Utility of the intervention measured using unvalidated questions asking about the intervention at 7 days post discharge
6. Unplanned readmissions at 60 and 90 days, measured using routinely collected data
Overall trial start date
01/08/2019
Overall trial end date
31/03/2022
Reason abandoned (if study stopped)
Eligibility
Participant inclusion criteria
1. Aged 75 and over
2. Anticipated to be discharged to their own home or that of a relative’s (this can include a period of rehabilitation after hospital discharge)
3. Stayed for at least one night on a participating ward
4. Ability to read and understand English or has a carer that can read and understand English
5. Willing and able to give informed consent (or personal consultee if lacking in mental capacity)
Participant type
Patient
Age group
Senior
Gender
Both
Target number of participants
Planned Sample Size: 1000 consented, 5440 non-consented; UK Sample Size: 1000 consented, 5440 non-consented
Participant exclusion criteria
Current participant exclusion criteria as of 07/08/2020:
1. Patients who have previously been recruited to the study (e.g. during a different admission or on a different ward)
2. Patients / Consultees who require an interpreter (e.g. because they are unable to read or understand English).
3. Patients who live out of the area included in the study
4. Patients who are expected to be transferred to another acute hospital/trust prior to discharge
5. Admitted for psychiatric reasons (other than dementia/delirium)
6. Nursing/residential home resident or planning to be discharged to a nursing / residential home on a permanent basis
7. Identified as being at the end of their life / subject to fast-track discharge to palliative care
8. Unable to give informed consent and where a suitable personal consultee cannot be identified, or if no one is prepared to act as a consultee for the patient
Previous participant exclusion criteria:
1. Out of area patients and/or patients who are to be transferred to another hospital
2. Admitted for psychiatric reasons (other than dementia/delirium)
3. Nursing/residential home resident or planning to be discharged to a nursing/residential home on a permanent basis
4. Less than one overnight stay (on the participating ward)
5. Identified as being at the end of their life/subject to fast-track discharge to palliative care
6. Unable to read and understand English and without a carer who can read and understand English
7. Unable to give informed consent and where a suitable personal consultee cannot be identified, or if no one is prepared to act as a consultee for the patient
8. On an acute medical admission unit and to be transferred to another ward within the hospital
Recruitment start date
16/11/2020
Recruitment end date
16/11/2021
Locations
Countries of recruitment
United Kingdom
Trial participating centre
Hull And East Yorkshire Hospitals NHS Trust
Hull Royal Infirmary
Anlaby Road
Hull
HU3 2JZ
United Kingdom
Trial participating centre
York Teaching Hospital NHS Foundation Trust
York Hospital
Wigginton Road
York
YO31 8HE
United Kingdom
Trial participating centre
Calderdale and Huddersfield NHS Foundation Trust
Royal Infirmary
Acre Street
Huddersfield
HD3 3EA
United Kingdom
Trial participating centre
Barnsley Hospital NHS Foundation Trust
Gawber Road
Barnsley
S75 2EP
United Kingdom
Trial participating centre
Bradford Teaching Hospitals NHS Foundation Trust
Bradford Royal Infirmary
Duckworth Lane
Bradford
BD9 6RJ
United Kingdom
Trial participating centre
Doncaster And Bassetlaw Teaching Hospitals NHS Foundation Trust
Doncaster Royal Infirmary
Armthorpe Road
Doncaster
DN2 5LT
United Kingdom
Trial participating centre
Harrogate And District NHS Foundation Trust
Strayside Wing
Harrogate District Hospital
Lancaster Park Road
Harrogate
HG2 7SX
United Kingdom
Trial participating centre
Leeds Teaching Hospitals NHS Trust
St. James's University Hospital
Beckett Street
Leeds
LS9 7TF
United Kingdom
Sponsor information
Organisation
Bradford Teaching Hospitals NHS Foundation Trust
Sponsor details
c/o Mrs Jane Dennison
Bradford Royal Infirmary
Duckworth Lane
Bradford
BD9 6RJ
United Kingdom
+44 (0)1274 382575
Jane.Dennison@bthft.nhs.uk
Sponsor type
Hospital/treatment centre
Website
Funders
Funder type
Government
Funder name
NIHR Central Commissioning Facility (CCF); Grant Codes: RP-PG-1214-20017
Alternative name(s)
Funding Body Type
Funding Body Subtype
Location
Funder name
National Institute for Health Research (NIHR) (UK)
Alternative name(s)
NIHR
Funding Body Type
government organisation
Funding Body Subtype
National government
Location
United Kingdom
Results and Publications
Publication and dissemination plan
1. Peer reviewed scientific journals
2. Internal report
3. Conference presentation
4. Publication on website
IPD sharing statement
The data sharing plans for the current study are unknown and will be made available at a later date
Intention to publish date
01/06/2023
Participant level data
To be made available at a later date
Basic results (scientific)
Publication list
Publication citations
Additional files
- ISRCTN17062524_PROTOCOL_v1_12Dec19.docx Uploaded 11/02/2020
- ISRCTN17062524_PIS_v1_10Oct19.docx Uploaded 11/02/2020