Baxter Ruth, Murray Jenni, Cockayne Sarah, Baird Kalpita, Mandefield Laura, Mills Thomas, Lawton Rebecca, Hewitt Catherine, Richardson Gerry, Sheard Laura, O'Hara Jane K
Yorkshire Quality and Safety Research Group, Bradford Institute for Health Research, Bradford, UK.
School of Psychology, University of Leeds, Leeds, UK.
Pilot Feasibility Stud. 2022 Oct 1;8(1):222. doi: 10.1186/s40814-022-01180-3.
The 'Your Care Needs You' (YCNY) intervention aims to increase the safety and experience of transitions for older people through greater patient involvement during the hospital stay.
A cluster randomised controlled feasibility trial was conducted on NHS inpatient wards (clusters) where ≥ 40% of patients were routinely ≥ 75 years. Wards were randomised to YCNY or usual care using an unequal allocation ratio (3:2). We aimed to recruit up to 20 patients per ward. Follow-up included routine data collection and questionnaires at 5-, 30-, and 90-days post-discharge. Eligible patients were ≥ 75 years, discharged home, stayed overnight on participating wards, and could read and understand English. The trial assessed the feasibility of delivering YCNY and the trial methodology through recruitment rates, outcome completion rates, and a qualitative evaluation. The accuracy of using routinely coded data for the primary outcome in the definitive trial was assessed by extracting discharge information for up to ten nonindividual consenting patients per ward.
Ten wards were randomised (6 intervention, 4 control). One ward withdrew, and two wards were unable to deliver the intervention. Seven-hundred twenty-one patients were successfully screened, and 161 were recruited (95 intervention, 66 control). The patient post-discharge attrition rate was 17.4% (n = 28). Primary outcome data were gathered for 91.9% of participants with 75.2% and 59.0% providing secondary outcome data at 5 and 30 days post-discharge respectively. Item completion within questionnaires was generally high. Post-discharge follow-up was terminated early due to the COVID-19 pandemic affecting 90-day response rates (16.8%). Data from 88 nonindividual consenting patients identified an error rate of 15% when using routinely coded data for the primary outcome. No unexpected serious adverse events were identified. Most patients viewed YCNY favourably. Staff agreed with it in principle, but ward pressures and organisational contexts hampered implementation. There was a need to sustain engagement, provide clarity on roles and responsibilities, and account for fluctuations in patients' health, capacity, and preferences.
If implementation challenges can be overcome, YCNY represents a step towards involving older people as partners in their care to improve the safety and experience of their transitions from hospital to home.
ISRCTN: 51154948.
“你的护理需要你”（YCNY）干预措施旨在通过在住院期间让患者更多地参与，提高老年人转院的安全性和体验。
在国民保健服务（NHS）的住院病房（群组）中进行了一项群组随机对照可行性试验，这些病房中≥40%的患者通常年龄≥75岁。病房以不等的分配比例（3:2）随机分为YCNY组或常规护理组。我们的目标是每个病房招募多达20名患者。随访包括出院后5天、30天和90天的常规数据收集和问卷调查。符合条件的患者年龄≥75岁，出院回家，在参与试验的病房过夜，并且能够阅读和理解英语。该试验通过招募率、结果完成率和定性评估，评估了实施YCNY和试验方法的可行性。通过提取每个病房多达十名未签署个人同意书患者的出院信息，评估在确定性试验中使用常规编码数据作为主要结局的准确性。
十个病房被随机分组（6个干预组，4个对照组）。一个病房退出，两个病房无法实施干预措施。成功筛查了721名患者，招募了161名（95名干预组，66名对照组）。患者出院后的失访率为17.4%（n = 28）。91.9%的参与者收集到了主要结局数据，分别有75.2%和59.0%的参与者在出院后5天和30天提供了次要结局数据。问卷中的项目完成率总体较高。由于新冠疫情影响了90天的回复率（16.8%），出院后随访提前终止。从88名未签署个人同意书的患者数据中发现，使用常规编码数据作为主要结局时错误率为15%。未发现意外的严重不良事件。大多数患者对YCNY持积极态度。工作人员原则上表示认同，但病房压力和组织环境阻碍了实施。需要持续保持参与度，明确角色和职责，并考虑患者健康、能力和偏好的波动情况。
如果能够克服实施挑战，YCNY代表着朝着让老年人成为其护理伙伴迈出的一步，以改善他们从医院到家的转院安全性和体验。
国际标准随机对照试验编号：51154948。
