“Discharge to Assess” (D2A) focuses on a model developed to provide short-term, funded support to patients who no longer require an acute hospital bed. This model allows for an assessment of their longer-term needs to be made in their own home or another community setting, such as a care home. The goal is to increase acute bed availability and improve patient quality of life by avoiding negative outcomes associated with longer hospital stays. The D2A model is described as a ‘complex adaptive system’ with guidelines and rules that can be adapted to suit the needs of patients, caregivers, and hospital staff in various scenarios.
The project was to evaluate the implementation of D2A models in the Kent, Surrey and Sussex region. This evaluation was funded by NHS England as part of the National Insights Priority Programme. It was conducted by the Kent, Surrey, Sussex Academic Health Science Network, Unity Insights and the Applied Research Collaboration Kent, Surrey, Sussex (ARCKSS).
Unity Insights supported with the development of a measurement framework to provide a blueprint to monitor success for wider implementation of the model nationally.
Unity Insights utilised the work conducted by ARCKSS, as well as additional desktop research, to develop a framework and logic model for measuring the implementation and impact of D2A in the NHS. This was supplemented with a metrics library, mapped to the logic model, with data sources identified and any calculations defined. Metrics from existing data sources were leveraged in order to reduce the burden on care providers.
The measurement framework was developed in the context of the substantial changes brought by D2A itself, which focuses much more on interoperability and joint-working to maximise impact. With data remaining segmented, Unity Insights were able to work with project partners and the feedback from the evaluation team to develop measurement approaches that bridged the gaps in standard datasets, while minimising the costs and effort required for providers.
The key findings of the report were as follows:
There is currently no national standardised survey to understand patient and carer experiences after discharge. This is detrimental as improving the experience and outcomes for these individuals is a key aim of the D2A pathway. Currently, any patient and carer experience or outcome data is often not measured in relation to acute hospital discharge, or where it is measured it is inconsistent, which renders quality improvement and comparisons across patient groups and HCPs challenging to conduct.
There is currently no centralised patient database for D2A patients, which inhibits the tracking of patients on the pathway and can harm efficient information sharing between organisations and stakeholders along the pathway. This prevents programme managers and multidisciplinary teams from engaging in effective quality improvement activity.
Currently, there is no information source at a national scale that can be used to assess how D2A has been implemented in different regions for quality improvement purposes.
Recommendations are made to address each of these gaps with the aim of supporting oversight, demonstrating impact and enabling the sharing of learnings at a national scale.
The measurement framework was developed to support the wider spread of D2A, encouraging best practice and enabling quality improvement.
