Developing a programme theory and intervention delivery plan to reduce high readmission rates for patients following intensive care admission

Summary:
A large number of patients survive a critical illness following intensive care admission every year in Scotland. About 25% of these patients are often readmitted within 90 days of discharge from hospital. At present, no evidence-based person-centred pathways exist for these patients that might potentially prevent readmission. The SCARF project (Supporting Community Recovery and Reducing Readmission Risk Following Critical Illness), developed a screening tool to help identify and trial a care pathway for ‘perfect storm’ cases admitted to intensive care unit (ICU). However, in order to refine this potentially preventative and anticipatory care further, a robust programme theory was required to underpin an intervention suitable for wider implementation and evaluation involving ICU patients with the ‘perfect storm’ profile. The 6SQuID framework will be used in this project.

Aim:
To develop a comprehensive and transparent programme theory and intervention delivery plan that will underpin subsequent implementation and evaluation.
Objectives:
• To engage multiple stakeholders in order to fully understand the problem of post-ICU readmission
• To identify key contributing factors relating to post-ICU readmission
• To develop and refine a programme theory that details how to bring about change in these key contributory factors
• To identify and refine potential activities that can generate change (intervention delivery plan).

Funder:
Chief Scientist Office

Timeline:
August 2019 – January 2020

Partners:
SCPHRP: Dr Larry Doi, Audrey Buelo and Dr Jan Pringle

SCARF: Professor Timothy Walsh (Principal Investigator); Dr Sheila Rodgers, Edward Donaghy and the rest of the SCARF team

For further information about this project please contact: larry.doi@ed.ac.uk

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Realist evaluation of the Universal Health Visiting Pathway

Summary:
In 2013, the Chief Nursing Officer for Scotland’s Future Focus CEL 13 letter directed all Health Boards to refocus the existing role of the health visitor as part of an enhanced Universal Health Visiting Pathway (UHVP). This is towards the delivery of preventative and targeted interventions, delivered by a health visitor workforce better equipped to address the specific needs of children and families. The new pathway includes a universal assessment timeline that increases the number of assessment contact with children and families. All families will receive eleven home visits from pre-birth until the child is 5 years old, with additional support provided to families depending on their level of need. We have been commissioned by the Scottish Government to undertake an evaluation of the UHVP across Scotland. The evaluation will be conducted in two phases.

The evaluation has five key components:
1. Review of the logic model workshops, including intended outcomes with key stakeholders
2. Qualitative interviews and focus groups with parents and health visitors (within five selected Health Boards – NHS Borders, NHS Tayside, NHS Lothian, NHS Grampian, NHS Ayrshire and Arran)
3. Case note review to be conducted within the five selected Health Boards
4. Surveys of parents and health visitors across Scotland
5. Review of routine data (analysis of anonymised national data from eDRIS)

Aims/objectives:
• Examine what elements of the UHVP are being implemented in which areas, when and how.
• Determine the extent to which the UHVP is implemented and delivered across Scotland and assess any associated impacts
• Identify and explain the extent to which recommendations from phase one are delivered and their impacts on services, staff, children and families.

Funder:
Scottish Government

Timeline:
July 2018 – December 2022

Project Team:
Dr Larry Doi (Principal Investigator); Prof Ruth Jepson, Kathleen Morrison (SCPHRP); Dr Louise Marryat, Dr Racheal Wood (Salvesen Mindroom Research Centre, University of Edinburgh); Dr Ruth Astbury (University of West of Scotland); Rachel Ormston, Jane Eunson, Rachel Warren (Ipsos MORI)

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Promoting Transportation Safety in Adolescence

Summary

The application will address the leading cause of death for adolescents, motor vehicle crashes. Evidence is emerging that comprehensive parenting programs and on-road driver assessment and feedback can optimize the learner’s permit period and possibly reduce crashes. The current best-practice policy approach to teen driver MVC prevention are state-level Graduated Driver Licensing (GDL) programs; however, GDL’s success has come from its focus on restricting access to high risk contexts and not on directly improving novice adolescent drivers’ competence. While additional public health benefit can be obtained by directly addressing this issue, existing training programs and models have not been successful. Therefore, there is a critical unmet need for novel efficacious interventions that target young drivers’ inexperience directly to complement the strong and policy-level structure put in place by GDL. The current application addresses this need.

In the proposed study we will evaluate a comprehensive program that consists of both parent- and teen-directed components. For teens, there is a state-of-the art on-road driver assessment (ODA).  For parents, there are face-to-face parent sessions with a trained facilitator and learning-to-drive handbook. These are designed to improve parent engagement across a wide range of parenting behaviors related to the learner and intermediate periods of GDL. This comprehensive parent-teen intervention (PTI) improves on existing programs by jointly targeting both parents and teens and utilizes data from R03HD082664 that indicates the ODA reduces crash risk by an estimated 53%.

Objective

Our Team is conducting a randomized controlled trial with 1,200 parent-teen dyads to evaluate our central hypothesis, which is that the comprehensive parent- and teen-directed intervention administered during the learner period of GDL can reduce the proportion of adolescent drivers who are in a motor vehicle crash (MVC) during the first 12 months of licensure compared to a usual practice control condition.

Funder

US National Institutes of Health

Timeline

Sept 1, 2018 – June 30, 2023

Partners

Dr. Catherine C. McDonald, University of Pennsylvania: https://www.nursing.upenn.edu/live/profiles/26-catherine-c-mcdonald

For further information about this project please contact Dr Jessica Hafetz at jessica.hafetz@ed.ac.uk

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Latest Projects

Developing a programme theory and intervention delivery plan to reduce high readmission rates for patients following intensive care admission (December 10, 2019)

Summary: A large number of patients survive a critical illness following intensive care admission every year in Scotland. About 25% of these patients are often readmitted within 90 days of discharge from hospital. At present, no evidence-based person-centred pathways exist for these patients that might potentially prevent readmission. The SCARF project (Supporting Community Recovery and […]

Read More


Realist evaluation of the Universal Health Visiting Pathway (December 10, 2019)

Summary: In 2013, the Chief Nursing Officer for Scotland’s Future Focus CEL 13 letter directed all Health Boards to refocus the existing role of the health visitor as part of an enhanced Universal Health Visiting Pathway (UHVP). This is towards the delivery of preventative and targeted interventions, delivered by a health visitor workforce better equipped […]

Read More


Promoting Transportation Safety in Adolescence (November 5, 2019)

Summary The application will address the leading cause of death for adolescents, motor vehicle crashes. Evidence is emerging that comprehensive parenting programs and on-road driver assessment and feedback can optimize the learner’s permit period and possibly reduce crashes. The current best-practice policy approach to teen driver MVC prevention are state-level Graduated Driver Licensing (GDL) programs; […]

Read More


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