Lead: Prof Sara Damary
Dates: November 2024 – October 2025
Background:
NHS England has identified respiratory care as one of five clinical areas in which there are substantial health inequalities that may disproportionately affect those in the most deprived 20% of the population and/or those from ethnic minority communities or with other protected characteristics (CORE20PLUS5). Addressing these inequalities is an NHS England priority, with integrated respiratory care proposed as a key means of optimising service organisation and delivery. Integrated respiratory care aims to be patient-centred, delivering care that is seamless, proactive and co-ordinated through clinical leadership and the multi-professional team working together across organisations, healthcare settings and pathways.
NHS England endorses a proactive approach to COPD management, particularly over the winter period when acute exacerbations are most likely to occur. It is expected that by identifying those with rising risk of exacerbation and putting in place processes of care to reduce exacerbations, this will decrease symptoms that need the input of primary care, emergency services and hospital admissions. This approach also aims to reduce inequalities in access to services, and improve quality of care, patient experience and outcomes by providing targeted and proactive personalised COPD care at key points in the respiratory pathway. NHS England suggests that key elements of this approach should include identification of at-risk patients, care optimisation through integrated respiratory specialist review, supporting patient self-management and education, and strengthening support to those exacerbating e.g. through 7 day services.
Policy and Practice Partners:
Birmingham and Solihull ICB
University of Birmingham
Midlands and Lancashire Commissioning Support Unit
Co-funding partners:
ARC West Midlands
Birmingham and Solihull ICB
Aims and objectives:
This project entails an evaluation of three approaches to COPD stratification to be undertaken in four localities across BSol ICB during 2024-25 winter. This will determine if high risk patients can be accurately identified in primary care to allow proactive intervention to reduce their risk of exacerbation and improve their respiratory health. A randomised design is being used, so that the relative effectiveness of different risk stratification tools can be assessed. After the new risk stratification approach has been embedded, quantitative data will be analysed, and interviews will be undertaken with GP practices, healthcare staff and patients to understand its impact as part of the evaluation being undertaken by University of Birmingham.
Methods:
The approach that will be evaluated in this project will be implemented using a design that allows multiple comparisons, cluster randomising primary care practices (at practice rather than individual patient level) within four localities across BSol ICB (East, Solihull, South and Central) to receive either intervention (risk stratification and integrated specialist COPD care) or control (usual care for risk stratification plus integrated specialist COPD care).
A mixed methods process and outcomes evaluation will combine qualitative (semi-structured interviews with patients and healthcare professionals) and routinely available quantitative data. The evaluation will be undertaken jointly between ARC West Midlands and the Midlands and Lancashire Commissioning Support Unit.
Quantitative outcomes will be assessed using routinely collected data which will be collated and analysed by Midlands and Lancashire Clinical Support Unit (MLCSU) and compared where relevant to data from the same period in the last 12 months. Differences over time and between arms/localities will be assessed using a difference-in-difference analysis at the GP practice level. Sub-group analysis will also allow assessment of outcomes for patients from CORE20PLUS populations to assess accessibility and impact on the basis of patient ethnicity and socioeconomic deprivation. To understand the impact of service expansion and service changes and patient and healthcare professional views and experiences of COPD risk stratification, qualitative data will be collected from up to 20 semi-structured interviews (up to 10 with patients; up to 10 with healthcare professionals including GPs, practice nurses and members of the respiratory multidisciplinary team.
Protocol:
N/A
Publication:
Awaited