The HOMEWARD Project

Study team

• Dr Sarah Voss, UWE Bristol (Chief Investigator)
• Professor Jonathan Benger, UWE Bristol
• Sarah Black, South Western Ambulance Service NHS Foundation Trust
• Dr Janet Brandling, UWE Bristol
• Dr Marina Buswell, University of Hertfordshire
• Professor Rik Cheston, UWE Bristol
• Dr Sarah Cullum, University of Auckland
• Kim Kirby, South Western Ambulance Service NHS Foundation Trust
• Professor Sarah Purdy, University of Bristol
• Chris Solway, Alzheimer's Society Research Network
• Dr Hazel Taylor, University of Bristol

Collaborators

• Theresa Foster, East of England Ambulance Service NHS Trust
• Larissa Prothero, East of England Ambulance Service NHS Trust.

Study summary

Older people with multiple health problems often call a 999 ambulance. Where one of these health problems is dementia, the risk of ambulance use, accident and emergency (A&E) attendance and hospital admission are all increased. It is important to try and reduce this, as patients with dementia tend to have poor outcomes when they are taken to A&E or admitted to hospital unnecessarily.

This study aims to find out why older people with multiple health issues including dementia are taken to hospital by ambulance, instead of being treated in the community. This will build on earlier work to find the true burden of dementia on pre-hospital care. It will look at the length of time paramedics spend at the scene, factors guiding the decision to transport and alternatives to A&E visits and hospital admissions.

This research is being carried out in partnership with University Hospitals Bristol NHS Foundation Trust, South Western Ambulance Service NHS Foundation Trust and East of England Ambulance Service NHS Trust.

There will be three phases of work:

Phase 1: Retrospective data analysis

Quantitative methods will be used to explore how often ambulances are called to older people with dementia. The issues considered will be:

• time and resources associated with these calls
• who the call was made by
• primary and secondary reasons for the 999 call
• frequency with which these calls result in the patient being conveyed to hospital.

Phase 2: Observational case studies

We will use a phenomenological approach to focus on understanding why these patients are conveyed to A&E when they have an injury or illness that could be treated at home or in the community. Detailed case studies will be compiled using a combination of observation, interview and documentation analysis, to study the factors influencing the paramedic decision-making process.

Phase 3: Needs Analysis

We will hold three nominal groups with paramedics to investigate and prioritise the resources that would allow emergency, urgent and out-of-hours care to be effectively delivered to a person with dementia at home or in a community setting, rather than conveyance to A&E with the resulting risk of acute hospital admission.

This proposal will answer important questions relevant to improving the care of people with dementia by investigating issues specific to the ambulance service that influence the risk of these patients requiring hospital care, instead of being cared for in or close to their own home. The results will inform important downstream investigations and feed into a larger ongoing programme of work to develop and evaluate the alternatives to hospital care.

Funding

The study is government funded, via the National Institute for Health Research's Research for Patient Benefit Programme (RfPB), and has received Health Research Authority (HRA) and ethics approval. This report is independent research funded by the National Institute for Health Research (Research for Patient Benefit Programme, Home or hospital for people with dementia and one or more other multimorbidities: What is the potential to reduce avoidable emergency admissions?, PB-PG-0215-36098).

The views expressed in this publication are those of the author(s) and not necessarily those of the NHS, the National Institute for Health Research or the Department of Health.

Key outputs

• Benger, J., Voss, S., Black, S., Brandling, J., Buswell, M., Cheston, R., Black, S.; Buswell, M.; Cullum, S.; Kirby, K.; Purdy, S.; Solway, C.; Taylor, H. (2017). Home or hospital for people with dementia and one or more other multimorbidities: What is the potential to reduce avoidable emergency admissions? The HOMEWARD Project Protocol. BMJ Open, 7(4), e016651.
• Voss, S., Brandling, J., Taylor, H., Black, S., Buswell, M., Cheston, R., Cullum, Sarah; Foster, Theresa; Kirby, Kim; Prothero, Larissa; Purdy, Sarah; Solway, Chris; Benger, J. R. (2018). How do people with dementia use the ambulance service? A retrospective study in England: The HOMEWARD project. BMJ Open, 8(7), e022549.

Project contact

For further information about the study, please contact: Dr Sarah Voss (Chief Investigator) at Sarah.Voss@uwe.ac.uk or Dr Janet Brandling (Researcher) at Janet2.Brandling@uwe.ac.uk.