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Theme: Evidence for Policy and Practice
This project arose from the PenCLAHRC research question prioritisation process. It was ranked highly by PenCLAHRC partners on potential for health gain, size of the problem and alignment with current priorities. Originally, worded to investigate the effectiveness of services in reducing acute admissions, it became apparent that variation in care existed across the region and that the current provision of this type of service was not well understood. This project is therefore proposed to meet a gap in knowledge of current health systems in the region.
Preliminary discussions with two local organisations indicated that community rapid intervention services vary in their scope and configuration across the South West Peninsula, both within and between organisations. The National Audit of Intermediate Care, which had been identified as containing these data, do not report these service variations and their structured categorisation created some doubts regarding data representation. Therefore, in order to better understand how rapid interventions, also known as crisis response, services work and what contributes to effectiveness, we first need to understand the baseline variety present in current services.
To identify and map all services in the community that have been commissioned to provide a rapid intervention for people at risk of being admitted to hospital.
An initial investigation identified that the National Intermediate Care Audit, conducted by NHS Benchmarking, collected data falling within our remit but described with different terminology – as Crisis Response. Many of our regional stakeholders participated in this audit. Rather than create our own data collection tool, it was decided to engage with stakeholders about their audit data, asking specifically for crisis response/rapid response services/urgent intermediate care referrals.
We engaged with stakeholder and service providers to identify where and how rapid interventions are being employed in the community.
Contact with service providers was initiated in writing from the AHSN and PenCLAHRC collaboration. Follow-up was conducted by the PenCLAHRC team, face-to-face, by telephone and e-mail.
Data was collected on:
In addition to the above data any documents pertaining to the service were collated, such as patient information leaflets, on-line information, written service agreements.
The data was analysed descriptively, summarising service coverage, both geographically and by patient type.
The initial project prioritisation process was attended by two PPI representatives and a PenCLAHRC PPI team member. PPI was ongoing throughout the project and dissemination process.
Rapid Intervention Services form part of a dynamic changing organisational landscape. Given this environment, our project has found that services have evolved in many different ways to fill niches in their local care pathways. We can make the following overarching observations:
A shared learning event held on 6th October 2016 brought together service providers and commissioners in the region to discuss study findings. The event allowed attendees to share information and experiences and facilitated the development of a network of people with shared interests in admissions avoidance.
For further information on the peer network, view our news story about the CRIS project.
Professor Ken Stein - Deputy Director of PenCLAHRC