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Study Title Study Lead Health & Social Care
Partner Organisations
Lay Summary
The effectiveness of interventions to achieve co-ordinated multi-disciplinary care and reduce hospital use for people with chronic diseases. Dr Sarah Damery,
University of Birmingham
  This systematic 'review of reviews' brings together the evidence about the effectiveness of interventions designed to provide integrated or co-ordinated care across different healthcare settings for patients with chronic diseases. Of particular interest are successful interventions or models of care which enhance patient experience, improve patient quality of life, reduce the use of hospital and other health services and allow healthcare cost savings to be made. Completed: April 2016.
View publication here.
Evaluating the predictive strength of the LACE index at identifying patients at high-risk of readmission to hospital following an inpatient episode. Dr Sarah Damery, University of Birmingham Sandwell and West Birmingham NHS Trust This work aimed to identify effective ways to reduce rates of 30-day readmissions following a hospital stay by assessing whether a risk prediction tool (the 'LACE' tool) which uses information on patient length of stay, admission type, other health conditions and previous emergency admissions, can predict accurately whether or not a patient is likely to be readmitted to hospital after being discharged. Completed: March 2016. View publication here.
HECTOR - Heartlands Elderly Care, Trauma & Ongoing Recovery Project. A service-level evaluation of a pilot programme designed to improve outcomes for elderly patients sustaining trauma injuries. Dr Sarah Flanagan,
University of Birmingham
Heart of England NHS Foundation Trust HECTOR is a service level intervention designed to improve outcomes for older patients who are admitted to hospital with trauma injuries. The intervention is being undertaken at Birmingham Heartlands Hospital. Our involvement with the project is to undertake an evaluation to measure patient related outcomes (levels of complications, length of stay in hospital, where patients are discharged to). We have also undertaken interviews with staff to learn about their experiences of delivering the new intervention. Evaluation completed: January 2019.
Integrating emotional and psychological support into the end-stage renal disease pathway: use of mixed methods to identify the most effective support to meet patients’ lower-level needs

Study initially led by Francesca Taylor, University of Birmingham

Current study lead: Dr Sarah Damery, University of Birmingham

University Hospital of North
Staffordshire NHS Trust; The Royal Wolverhampton NHS Trust; Heart of England NHS Trust; University Hospitals Coventry and Warwickshire
A 4-year programme of research designed and undertaken to support the lower level emotional and psychological needs of renal patients. Several stages of qualitative and quantitative research will be conducted among renal patients and clinicians. The findings will be used to develop an evidence-based framework for emotional and psychological support integrated into chronic kidney disease and end-stage renal disease pathways. Completion date: 2018.
Development and evaluation of a training
package to test the assessment, treatment and referral of osteoarthritis (OA) related pain and mental health conditions in an enhanced chronic disease review in primary care (study 2)
Dr Emma Healey,
Keele University
Various primary care settings  
An evidence synthesis to develop optimal
management packages for patients with pain and mental health problems and comorbid long term conditions in primary care
Dr Clare Jinks,
Keele University
Various primary care settings  
Getting to hospital at a single stroke. A crash course for GP receptionists on the recognition and handling of acute stroke Dr Elizabeth Bates
University of Birmingham
Various primary care settings A training project to help GP reception staff recognise stroke and TIA and to ensure patients reach appropriate care as quickly as possible. Findings from a previous study showed that for 20% of stroke patients in the West Midlands the first course of action is to telephone their GP when they realise that they may have the symptoms of a stroke. However, it was found that none of these patients were getting through for thrombolysis. Studies have shown that some delays occur after the patient has called their GP surgery. The median time to thrombolysis is 55 minutes after the onset of symptoms; however there is a delay in patients getting thrombolysed if they contacted primary care instead of calling for an ambulance. The project wanted to look in greater detail at this part of the pathway and what was happening when receptionists at GP surgeries took the call. The study is using trained medical role players, posing as patients or relatives, to make telephone calls to GP practices in order to find out what is said during the call and how receptionists perform. Completed: 2016.
Improving primary care for people with long term conditions: integrated working between general practice and adult social work teams Dr Robin Miller,
University of Birmingham
Staffordshire County Council &
Staffordshire CCG
This study has been designed to better understand the relationship between GPs and social workers, and to develop interprofessional educational resources (a toolkit) that both professions can use to improve collaboration. The project involves general practices and linked adult social work teams. Separate focus groups will be held for GPs and for the social work teams to find out their perception of each other’s professions; their experience of working together; and what would help them work better together. The findings will be used to arrange an interprofessional educational event to try to embrace some of issues raised. The same focus groups will be consulted after a 3-4 month period to determine whether there has been any improvement in collaborative working and to share with them the training resources that are being developed. Completed: 2015.
Evaluation of a programme to improve safety in care homes Dr Sarah Damery,
University of Birmingham
  Most patient safety initiatives have focused on hospitals, and relatively little work has been undertaken in care homes, even though care home residents are an increasingly frail and elderly population for whom adverse safety events can quickly escalate into hospital attendance and admission. This study is designed to evaluate a safety programme being funded by the West Midlands Patient Safety Collaborative, in which 30 care homes in two CCG areas will participate in a programme to skill up staff in service improvement techniques. The aim of the programme is to reduce the incidence of harm and improve safety culture in the participating homes. Training and workshops will be combined with facilitation of groups of staff in individual care homes who will also be undertaking local improvement projects. The evaluation will continue for two years and will use mixed methods, combining quantitative assessment of changes in safety culture and hospital admissions with qualitative staff interviews, focus groups and four in-depth care home case studies. Start date, October 2016. Completion date: 2019. View published protocol here.
Evaluation of Supported Integrated Discharge at Heart of England Foundation Trust Mrs Elaine O’Connell-Francischetto,
University of Birmingham
Heart of England NHS Foundation Trust The aim of this study is to explore how the Heartlands Hospital integrated discharge service works, and to understand the experiences of staff, patients and informal/formal carers involved in the service. The work will have 3 main components, first the service will be mapped by conducting semi-structured interviews with staff involved in managing and delivering the service. Then, further semi-structured interviews will be conducted with staff to explore their experiences of the service. Finally semi-structured interviews will be conducted with patients and their informal/formal carers. This process will allow an in depth exploration of how the service works and potential barriers, whilst also exploring what users think of the service. This work is being undertaken as part of a CLAHRC-WM PhD, and is due to be completed in 2022.
Virtual clinics versus standard face-to-face appointments for liver transplant patients in routine hospital care: a pragmatic randomised evaluation of myVirtualClinic. Mrs Elaine O’Connell Francischetto,
University of Birmingham
University Hospitals Birmingham NHS Foundation Trust University Hospitals Birmingham (UHB) are introducing virtual clinics for the follow-up care for liver transplant patients to reduce the need for patients to make unnecessary hospital visits. This study is in collaborating with colleagues at UHB to evaluate whether the virtual clinic improves patient satisfaction compared to standard face-to-face appointments for patients who have undergone a liver transplant. A randomised evaluation and embedded qualitative study will: (1) test the effectiveness of virtual clinics in terms of patient satisfaction; (2) evaluate the costs associated with virtual clinics compared to standard outpatient care; (3) explore experiences of the virtual clinics from the perspective of patients, carers and health professionals; and (4) assess whether a patient records portal can be used to collect study data. Completion date: 2019.
A Randomised Controlled Trial to investigate the effectiveness of ThOracic Epidural and Paravertebral Blockade In reducing Chronic Post-Thoracotomy Pain – TOPIC Feasibility Study Dr Sarah Flanagan, University of Birmingham Heart of England NHS Foundation Trust Surgery through the side of the chest (thoracotomy) causes pain post-operatively with more than half of patients developing chronic post-thoracotomy pain (CPTP) which can last for months or years.
TOPIC aimed to investigate the feasibility of undertaking a randomised controlled trial to explore the clinical and cost effectiveness of using PVB (Paravertebral blockade), which is a type of pain relief method. It is one of two commonly used methods of pain relief, the other being TEB (Thoracic epidural blockade). There is some evidence that PVB can reduce the likelihood of longer term pain for patients undergoing a thoracotomy. This feasibility study sought to clarify aspects of the trial such as how many patients will consent to be randomised to PVB or TEB and what factors motivate, or become barriers for clinicians and patients to agree to be randomised. The study findings indicated that it was possible to randomise and follow-up patients with high fidelity. Completed: February 2018.
The Impact of Giant Cell Arteritis (GCA) Study Prof Christian Mallen, Keele University    
The Joint Symptoms Questionnaire Study Prof Christian Mallen, Keele University    
Polymyalgia Rheumatica (PMR): a qualitative interview study of general practitioners Prof Christian Mallen, Keele University    
Survey of Physiotherapist INtervention with PMR patients (SPIN PMR) Prof Christian Mallen, Keele University    
Colchicine Or Naproxen Treatment for ACute gouT (CONTACT) Dr Ed Roddy, Keele University    
Stratified Care for Patients with Sciatica and Suspected Sciatica in Primary Care: A randomised trial (the SCOPiC trial - SCiatica Outcomes in Primary Care) Prof Nadine Foster, Keele University    
Improving the Care of People with Long Term Conditions (ENHANCE) Prof Christian Mallen, Keele University    
Smart Rehabilitation at Home before and after Lung Surgery (Fit for Surgery) Dr Sarah Flanagan, University of Birmingham Heart of England NHS Foundation Trust 5700 patients a year in the UK undergo major surgery to remove part of their lungs; primarily to cure cancer. A common post-operative complication is collapse or infection in the remaining lung. These complications are linked to increased risk of death, likelihood of admission into an intensive care unit and longer hospital stay. Furthermore, survivors of cancer have a range of physical, psychological, social, spiritual, and financial and information needs which are unmet. Avoidance of these complications and addressing unmet needs offers great benefits to patients. A comprehensive pulmonary rehabilitation programme (ROC- Shine 2010) of an out-patient based programme consisting of exercise training, self-management education, nutritional and smoking cessation support demonstrated improvement in complication and hospital readmission rates. Lack of immediate access to pulmonary rehabilitation programmes across the country has hampered spread. There is thus a need to develop a service that can be delivered immediately at the convenience and in control of the patient. The findings from the study indicated that an app-based programme of rehabilitation can be delivered in a timely and acceptable fashion to lung surgery patients with demonstrable physiological benefits. Completed: February 2017.
Evaluation of the Older Person's Assessment and Liaison service (OPAL) Dr Kiran Rai, University of Birmingham University Hospitals Birmingham NHS Foundation Trust Research has shown that comprehensive geriatric assessment for older adults admitted to hospital shows a significant improvement in the chances of a patient being alive and in their own home at up to a year after an emergency hospital admission if they receive co-ordinated specialist services. University Hospitals Birmingham have introduced a multidisciplinary geriatric assessment service for patients aged 70 years and over which operates at the point of hospital admission. The goal of the service, which includes consultant, nurse and therapist expertise, is to prevent admission for patients who do not need it. For those that are admitted to hospital, early and comprehensive assessment should positively influence their care and ensure their length of stay is shorter. CLAHRCWM has collaborated with colleagues at UHB to undertake a qualitative evaluation of the service. Completed: March 2017.
Discharge interventions for older patients leaving hospital: a systematic meta-review. Mrs Elaine O’Connell Francischetto, University of Birmingham   There is an increased need for additional care and support services for the older population. Although there is a large evidence base focusing on discharge services and their impact on patients which shows some potential benefits, it is unclear what elements of discharge interventions could be most beneficial to older people. This meta-review aims to identify existing systematic reviews of discharge interventions for older people, evaluate the effective elements of discharge services for this patient group and identify areas where further work may still be needed. This work is being undertaken as part of a CLAHRCWM PhD project, due to be completed in 2022. Published protocol here.
Introduction of a pharmacy and psychosocial intervention in care homes to limit the use of psychotropic medication to treat Behavioural and Psychological Symptoms of Dementia (BPSD) – a feasibility study Dr Sarah Damery, University of Birmingham Birmingham and Solihull Mental Health Foundation Trust ‘Behaviour that challenges’ is common in people with dementia who are resident in care homes. Such behavior has typically been treated with anti-psychotic medication. However, the use of anti-psychotics is associated with 1800 potentially avoidable deaths annually, and the UK Department of Health aims to reduce usage of anti-psychotics by two thirds. This study investigated the feasibility of a specialist dementia care pharmacist-led medication review combined with a health psychology intervention for care home staff to limit the use of anti-psychotic medication. Completed: May 2018.Published protocol here.
Modelling the effects of treatment frequency for home haemodialysis patients Dr Gill Combes, University of Birmingham University of Birmingham This work was undertaken for the Sheffield NIHT HTC for Devices for Dignity Collaborative. The aim of the project was to develop a cost effectiveness model for haemodialysis which is undertaken by patients at home more frequently than the standard prescription of 3 times per week. This study looked at the existing published data for patients doing: short daily haemodialysis, nocturnal haemodialysis, and haemodialysis on alternate days. It is hoped that the results of this project will provide evidence of cost effectiveness for a new model of haemodialysis delivery that may increase the independence and promote the dignity of patients, with a direct impact on their quality of life. Completed: 2015.
Feasibility of a brief weight management intervention embedded within routine health care consultations for the prevention of weight gain after renal transplant: RCT (PROMPT) Dr Helen Paretti UoB, UHBFT, University of Oxford
This is a randomised controlled trial investigating an intervention to prevent weight gain after a kidney transplant. The intervention will be embedded into routine follow up care after kidney transplantations so we are particularly interested in whether the intervention is practicable and acceptable to patients and doctors. Previous studies have shown that most people gain weight after a kidney transplant and this can affect how well the transplant works. Current guidelines suggest that kidney doctors should give advice to prevent weight gain, but this advice is often not given or it is inconsistent. In this study participants will be randomised to receive usual care plus weight management advice and feedback on their progress at their outpatient appointments or usual care only. The aim will be to prevent weight gain over six months. Patients will be able to participate if they are over 18 years and just had a first kidney transplant. At the end of the study we will interviews doctors, dietitians and participants to get feedback on the study and hear their views about the weight management intervention. The information from this study will contribute to the development of a larger trial in the future. The study will be conducted at Queen Elizabeth Hospital, Birmingham.
Scoping review of systematic reviews and RCTs focusing on polypharmacy and inappropriate prescribing interventions Mrs Elaine O’Connell Francischetto, University of Birmingham   Scoping review to describe the current evidence base regarding interventions used to aid polypharmacy and inappropriate prescribing and identify potential gaps in the literature to inform future research. Completed: 2019.
A rapid scoping review of systematic overview methodologies and search strategy effectiveness Mrs Elaine O’Connell Francischetto and Dr Sarah Damery, University of Birmingham   A rapid scoping review summarising the methods used in recent systematic review of reviews and informing recommendations for future reviews.
Audit of current outpatient clinical care for liver patients and the need for improvement Mrs Elaine O’Connell Francischetto, University of Birmingham University Hospitals
Birmingham NHS Foundation Trust
This work was led by Elaine O’Connell Francischetto and Katherine Arndtz who conducted an audit of outpatient care for pre and post-transplant patients. This audit helped to understand liver transplant patients’ opinions of their current outpatient care, current costs, current levels of technology use and their views of having virtual consultations. Completed: 2017.

Understanding the prevalence of multimorbidity in people of later working age and the impact of multimorbidity definition on characteristics of the cohort

Dr Sarah Damery, University of Birmingham


Multimorbidity presents a growing challenge for the organisation and delivery of NHS services. However, defining multimorbidity simply as the co-existence of two or more chronic conditions in the same individual may fail to identify those with the most complex needs who are likely to be more intensive users of health and social care services This study aims to understand the prevalence of multimorbidity in people of later working age (40 to 69), in a large sample of UK adults who enrolled to participate in the UK Biobank cohort between 2006-2010. Specific objectives are to: assess different approaches to defining and identifying multimorbidity in adults of later working age; investigate multimorbidity prevalence in the cohort identified using each approach to definition and assess any overlap between groups; determine the sociodemographic and lifestyle characteristics of patients identified in each approach to defining multimorbidity, and to compare the prevalence and characteristics of the cohort(s) with existing evidence on multimorbidity in the population aged 65+. Completion date: September 2019.

Identifying and managing distress in patients undergoing peritoneal dialysis

Dr Sarah Damery, University of Birmingham

Heart of England NHS Foundation Trust

This project is an extension of the larger study that aimed to understand how support for patients’ lower-level emotional and psychological difficulties can be integrated into the end stage renal disease pathway. Findings from the larger study suggested that patients undergoing peritoneal dialysis may have specific support needs and a potentially different ‘distress profile’ when compared to other renal patients and/or those being treated using other dialysis modalities. Consequently, this project comprises a targeted sub-study with patients on peritoneal dialysis at a single NHS Trust in the West Midlands, using a reduced version of the study questionnaire administered in the larger renal study. Completion date: 2019.

Coventry and Warwickshire Partnership Trust: Out of hospital services care model (OOHC)

Dr Gill Combes, University of Birmingham

Coventry and Warwickshire Partnership NHS Trust

This is an evaluation of a new out of hospital care model that has been developed for the people living in Coventry, Rugby and Warwickshire. It was developed during 2016 and 2017 with wide stakeholder involvement and has been designed around the needs of 15% of the population (high intensity service users; people with long-term conditions and healthy people who use more healthcare more often. The evaluation is in two phases. Phase 1 aims to identify factors governing the success or otherwise of previous complex change and to identify concepts and assumptions underlying the OOHC model and how these are expected to impact on the stated outcomes. Phase 1 completed: September 2018.

INTEGRATE: Transitions between renal replacement therapies: patients’ and staffs’ experience of transitioning from peritoneal dialysis to haemodialysis.

Mr Kim Sein, University of Birmingham

University Hospital Birmingham; University Hospital North Midlands; Royal Wolverhampton Hospital

Switching or transitioning from one type of renal replacement therapy to another is common in patients with end stage renal disease. The most common of these transitions seems to be moving from peritoneal dialysis to in-centre haemodialysis. This project will gather patient, carer, and staff experience of the transition journey by conducting qualitative, semi-structured interviews across three NHS Trusts. Understanding people’s experience will allow the project to suggest improvements to clinical practice. Completion date: December 2019.


Delays in discharge from hospital of older people living with frailty: what are the hidden challenges and can they be addressed?

Dr Gill Combes, University of Birmingham

University Hospitals Birmingham; North Bristol NHS Trust

The National Health Service struggles with ‘delayed transfers of care’ and the cost for the NHS of delays to discharge are estimated at around £820 million a year. While unnecessary stays of older people at hospital is costly for the NHS, the experience of long stays in hospital can also be detrimental to the overall health of older people. This research seeks to identify, understand and provide solutions for the causes of delays to discharges of older and frail people and their hidden challenges. The data collection at Queen Elizabeth Hospital Birmingham includes patients, their family members and professionals from different areas of expertise. The findings will produce knowledge to help healthcare professionals and policy makers to improve the process of discharge for older people. Completion date: December 2019