Evaluating the Preventative Integrated Care Service for adults living with chronic disease
Assessing programme development, effectiveness, and sustainability of the Preventative Integrated Care Service for adults living with chronic respiratory disease, chronic cardiovascular disease, and diabetes
Queensland University of Technology
100 participants
Jul 2, 2024
Observational
Conditions
Summary
This study aims to evaluate and identify the core components and implementation effectiveness of a novel, rapid, ambulatory subacute service for consumers living with one or more chronic diseases (diabetes, chronic respiratory disease, and/or chronic cardiovascular disease) - the Preventative Integrated Care Service. This research project will be looking at how the service operates, what contributes to successes and challenges in delivering the Preventative Integrated Care Service, what’s needed to successfully roll similar services out to other locations, and how the service can be adapted to overcome challenges to deliver high quality care to its patients.
Eligibility
Inclusion Criteria18
- There are four categories of participants for this research.
- a) Adopters - PICS Consumers: Consumers who have received PICS within the past six months. Service eligibility is defined as:
- i) Any patient that has a confirmed diagnosis of heart failure, and/or cardiovascular disease; and/or
- ii) Any patient with type 2 diabetes mellitus and HbA1c >8% or unstable diabetes requiring insulin or recent or current hospital admission related to diabetes, diabetic complications, or high risk foot; and/or
- iii) any patient with type 1 diabetes; and/or
- iv) any patient with a confirmed diagnosis of asthma, chronic obstructive pulmonary disease, bronchiectasis, interstitial lung disease, and/or pulmonary fibrosis; AND has/will experience(d) at least one of the following:
- v) Intensive care unit requirement during most recent admission;
- vi) Post discharge from complex respiratory/cardiac/diabetes disease related hospital admission;
- vii) At high risk of admission/readmission to hospital with a potentially preventable hospitalisation caused by their chronic condition;
- viii) Complex new diagnosis of chronic condition and social determinants;
- ix) Patient discharged on new home oxygen.
- b) Adopters and Implementers - PICS Staff who are delivering the service protocol: Staff who are current employees of the PICS.
- c) Implementation decision makers - Health service directors & executive directors: Hospital and Health Service staff who have professional and/or operational leadership delegation over one or more professional, clinical, or operational components of the PICS (e.g., Executive, Team Leader, Allied Health Directors, Informatics Managers) within the study period.
- d) Wider system referrers – general practitioners and other specialists within the catchment area: Primary care providers and referring Hospital and Health Service staff to the PICS.
- iv) Are currently residing in an Residential Aged Care Facility.
- b) Adopters and Implementers - Staff who are not current employees of the PICS.
- c) Implementation decision makers - Health service directors & executive directors: Hospital and Health Service staff who do not have professional and/or operational leadership delegation over one or more professional, clinical, or operational components of the PICS (e.g., Executive, Team Leader, Allied Health Directors, Informatics Managers) within the study period.
- d) Wider system referrers – general practitioners and other specialists operating outside of the catchment area, health professionals who have not yet referred to the PICS.
Exclusion Criteria3
- a) Adopters - PICS Consumers: PICS consumers who have not received PICS services in the past six months, Consumers who:
- i) Reside outside of service catchment;
- ii) Require high acuity care. e.g., Hospital in the Home, Emergency Department, or for Direct Admission to an inpatient unit.
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Interventions
The Preventative Integrated Care Service (PICS) is a rapid access, specialised, multidisciplinary, outpatient care model that was recently established in South-East Queensland, Australia. It provides a 14-day, rapid assessment and medical stabilisation service offering intensive specialised medical management of adults living with chronic respiratory diseases, chronic cardiovascular diseases, and/or diabetes. PICS is delivered by a specialist-led, multidisciplinary care team, and is delivered through multimodalities (e.g., in clinic, telephone, remote biometric monitoring, home visit). This programme was rolled out in South-East Queensland, Australia, was rolled out without implementation evaluation planning at its inception. This research will be conducted over three, six-month phases: - Phase 1: Context assessment (t1, August-September 2024). The primary outcomes of core components, programme determinants, and patient experiences, and secondary outcome of barriers and enablers will be identified and measured. - Phase 2: Process evaluation (t2, February-March 2025). The primary outcomes of fidelity and adoption will be measured. - Phase 3: Service iteration and adaption for quality improvement (t3, August-September 2025). The primary outcome of service iteration and adaption will be measured. There are four groups of participants that will be engaged in the research: - Adopters (Consumers): Patients who have received PICS. Consumers will be recruited to participate in 45-60min semi-structured interviews (one baseline, and a six-month follow-up) on their perspectives and experience of receiving the PICS. Patients will not be required to undertake additional physical or psychometric assessments. Patients will receive reciprocity for their time. Engagement of patients is only during Phase 1 Context assessment. Further detail is provided in Section 7 Recruitment. Deidentified, clinical patient information will be utilised for secondary outcome measurement (Phase 2 secondary outcome - clinical effectiveness) for data between t1 (01 August 2024) and t3 (01 August 2025). A waiver for consent has been approved by the Human Research Ethics Committee. - Adopters & implementers (PICS service delivery staff): Participants will be recruited at all three phases of research. Participation will involve semi-structured interviews (Phase 1 and 2), with the opportunity to provide feedback on interview summary notes to the researcher. A subsample of participants will be recruited to Phase 3, to participate in collaborative workshops for service iteration and adaption. Following the completion of their semi-structured interview, participants will be offered to the opportunity to nominate to participate in the collaborative workshop, A representative sample cross disciplines and professional delegation (i.e., clinician, team leader, executive) will be determined by the research team. The collaborative workshop will involve two x four-hour face-to-face workshops, facilitated by the research team. Active participation in responding to researcher queries and participating in conversation with colleagues will be required. The workforce profile for the PICS includes Nurse Practitioners, Registered Nurses, Senior Medical Officers, Dietitian, Pharmacist, Physiotherapists, Occupational Therapists, and Social Workers. - Implementation leaders and decision makers: Participants will be recruited at all three phases of research. Participation will involve semi-structured interviews (Phase 1 and 2), with the opportunity to provide feedback on interview summary notes to the researcher. A subsample of participants will be recruited to Phase 3, to participate in collaborative workshops for service iteration and adaption. Following the completion of their semi-structured interview, participants will be offered to the opportunity to nominate to participate in the collaborative workshop, A representative sample cross disciplines and professional delegation (i.e., clinician, team leader, executive) will be determined by the research team. - Wider system referrers: Participants will be recruited at Phase 3, with the opportunity to provide feedback on interview summary notes to the researcher.
Locations(1)
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ACTRN12624000757516