Piloting of a minimum data set for older people living in care homes in England: protocol for a longitudinal, mixed-methods study.

INTRODUCTION: Health and care data are routinely collected about care home residents in England, yet there is no way to collate these data to inform benchmarking and improvement. The Developing research resources And minimum data set for Care Homes' Adoption and use study has developed a prototype minimum data set (MDS) for piloting. METHODS AND ANALYSIS: A mixed-methods longitudinal pilot study will be conducted in 60 care homes (approximately 960 residents) in 3 regions of England, using resident data from cloud-based digital care home records at two-time points. These will be linked to resident and care home level data held within routine National Health Service and social care data sets. Two rounds of focus groups with care home staff (n=8-10 per region) and additional interviews with external stakeholders (n=3 per region) will explore implementation and the perceived utility of the MDS. Data will be assessed for completeness and timeliness of completion. Descriptive statistics, including percentage floor and ceiling effects, will establish data quality. For validated scales, construct validity will be assessed by hypothesis testing and exploratory factor analysis will establish structural validity. Internal consistency will be established using Cronbach's alpha. Longitudinal analysis of the pilot data will demonstrate the value of the MDS to each region. Qualitative data will be analysed inductively using thematic analysis to understand the complexities of implementing an MDS in care homes for older people. ETHICS AND DISSEMINATION: The study has received ethical approval from the London Queen's Square Research Ethics Committee (22/LO/0250). Informed consent is required for participation. Findings will be disseminated to: academics working on data use and integration in social care, care sector organisations, policy makers and commissioners. Findings will be published in peer-reviewed journals. Partner NIHR Applied Research Collaborations, the National Care Forum and the British Geriatrics Society will disseminate policy briefs.

Association between household context and emergency hospital use in older people: a retrospective cohort study on indicators for people living alone or living with somebody with frailty, developed from routine healthcare data in England.

OBJECTIVES: To derive two household context factors - living alone and living in a two-person household with a person who is frail - from routine administrative health data and to assess their association with emergency hospital use in people aged 65 or over. DESIGN: Retrospective cohort study using national pseudonymised hospital data and pseudonymised address data derived from a minimised version of the Master Patient Index, a central database of all patient registrations in England. SETTING: England-wide. PARTICIPANTS: 4 876 285 people aged 65 years or older registered at GP practices in England on 16 December 2018 who were living alone or in a household of up to six people, and with at least one hospital admission in the last 3 years. OUTCOMES: Rates of accident and emergency (A&E) attendance and inpatient emergency admissions over a 1-year follow-up period. RESULTS: Older people living alone had higher rates of A&E attendances (adjusted rate ratio 1.09, 95% CI 1.09 to 1.10) and emergency admissions (1.14, 95% CI 1.14 to 1.15) than older people living in households of 2-6 people. Older people living with someone with frailty in a two-person household had higher rates of A&E attendance (adjusted rate ratio 1.09, 95% CI 1.08 to 1.10) and emergency admissions (1.10, 95% CI 1.09 to 1.11) than other older people living in a two-person household. CONCLUSIONS: We show that household context factors can be derived from linked routine administrative health data and that these are strongly associated with higher emergency hospital use in older people. Using household context factors can improve analyses, as well as support in the understanding of local population needs and in population health management.

Developing a minimum data set for older adult care homes in the UK: exploring the concept and defining early core principles.

Reforms to social care in response to the COVID-19 pandemic, in the UK and internationally, place data at the heart of proposed innovations and solutions. The principles are not well established of what constitutes core, or minimum, data to support care home residents. Often, what is included privileges data on resident health over day-to-day care priorities and quality of life. This Personal View argues for evidence-based principles on which to base the development of a UK minimum data set (MDS) for care homes. Co-produced work involving care home staff and older people working with stakeholders is required to define and agree the format, content, structure, and operationalisation of the MDS. Implementation decisions will determine the success of the MDS, affecting aspects including data quality, completeness, and usability. Care home staff who collect the data need to benefit from the MDS and see value in their contribution, and residents must derive benefit from data collection and synthesis.

A novel method for identifying care home residents in England: a validation study.

INTRODUCTION: The ability to identify residents of care homes in routinely collected health care data is key to informing healthcare planning decisions and delivery initiatives targeting the older and frail population. Health-care planning and delivery implications at national level concerning this population subgroup have considerably and suddenly grown in urgency following the onset of the COVID-19 pandemic, which has especially hit care homes. The range of applicability of this information has widened with the increased availability in England of retrospectively collected administrative databases, holding rich patient-level details on health and prognostic status who have made or are in contact with the National Health Service. In practice lack of a national registry of care homes residents in England complicates assessing an individual's care home residency status, which has been typically identified via manual address matching from pseudonymised patient-level healthcare databases linked with publicly availably care home address information. OBJECTIVES: To examine a novel methodology based on linking unique care home address identifiers with primary care patient registration data, enabling routine identification of care home residents in health-care data. METHODS: This study benchmarks the proposed strategy against the manual address matching standard approach through a diagnostic assessment of a stratified random sample of care home post codes in England. RESULTS: Derived estimates of diagnostic performance, albeit showing a non-insignificant false negative rate (21.98%), highlight a remarkable true negative rate (99.69%) and positive predictive value (99.35%) as well as a satisfactory negative predictive value (88.25%). CONCLUSIONS: The validation exercise lends confidence to the reliability of the novel address matching method as a viable and general alternative to manual address matching.

Effect of an integrated care pathway on use of primary and secondary healthcare by patients at high risk of emergency inpatient admission: a matched control cohort study in Tower Hamlets.

OBJECTIVES: To assess the effects of an integrated care pathway on the use of primary and secondary healthcare by patients at high risk of emergency inpatient admission. DESIGN: Observational study of a real-life deployment of integrated care, using patient-level administrative data. Regression analysis was used to compare integrated care patients with matched controls. SETTING: A deprived, inner city London borough (Tower Hamlets). PARTICIPANTS: 1720 patients aged 50+ years registered with a general practitioner in Tower Hamlets and at high risk of emergency inpatient admission enrolled onto integrated care during 2014. These patients were matched to control patients, also selected from Tower Hamlets, with respect to demographics, diagnoses of health conditions, previous hospital use and risk score. INTERVENTIONS: Enrolled patients were eligible for a range of interventions, such as case management, support with self-care and enhanced care coordination. Control patients received usual care. PRIMARY AND SECONDARY ENDPOINTS: Number of emergency inpatient admissions in the year after enrolment onto integrated care. Secondary endpoints included numbers of elective inpatient admissions, inpatient bed days, accident and emergency attendances, outpatient attendances and general practitioner contacts in the year after enrolment. RESULTS: There was no evidence that the integrated care pathway reduced patients' healthcare utilisation in the first year post-enrolment. Matched controls and integrated care patients were similar at baseline. Following enrolment, integrated care patients were more likely than matched controls to experience elective inpatient admissions (adjusted incidence rate ratio (IRR)=1.27, 95% CI 1.08 to 1.49, p=0.004). They were also more likely to experience general practitioner contacts (adjusted IRR=1.11, 95% CI 1.06 to 1.16, p<0.001), but other endpoints were not significantly different between the groups. CONCLUSIONS: The integrated care pathway was not associated with a reduction in healthcare utilisation in the first year, but appeared to have increased elective inpatient admissions and general practitioner workload.

Investigating the Task Dependency of Viewing Time Effects.

The viewing time method (VT) is an indirect measure of sexual interest in which participants are usually asked to rate the sexual attractiveness of target stimuli while their response latencies are unobtrusively measured. Higher response latencies for a certain group of depicted individuals indicate sexual interest in that group. Contrary to the general assumption that the picture content accounts for this effect by eliciting affect- or attention-based response delays, we hypothesized that the attractiveness rating task might be responsible for the VT effect. To test this hypothesis, we used two different tasks. Our heterosexual and homosexual male participants (N = 50) were instructed to rate the attractiveness or the sex of the depicted individuals. As expected, VT effects only emerged in attractiveness rating trials. Based on these findings, we conclude that VT effects are task dependent and are unlikely to be caused by affective or attentional processes (at least when participants are instructed to rate the attractiveness of target stimuli). We argue that rating tasks in VT measures cause participants to use affect independent response strategies. These response strategies seem to undermine stimulus-driven processes (like increased attention directed toward salient stimuli) which were thought to cause VT effects according to previous hypotheses.