Evaluation of a health and social care programme to improve outcomes following critical illness: a multicentre study

At present, clinicians aiming to support patients through the challenges after critical care have limited evidence to base interventions. Evaluate a multicentre integrated health and social care intervention for critical care survivors. A process evaluation assessed factors influencing the programme...

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Bibliographic Details
Published in:	Thorax Vol. 78; no. 2; p. 160
Main Authors:	Henderson, Philip, Quasim, Tara, Shaw, Martin, MacTavish, Pamela, Devine, Helen, Daniel, Malcolm, Nicolson, Fiona, O'Brien, Peter, Weir, Ashley, Strachan, Laura, Senior, Lorraine, Lucie, Phil, Bollan, Lynn, Duffty, Jane, Hogg, Lucy, Ross, Colette, Sim, Malcolm, Sundaram, Radha, Iwashyna, Theodore J, McPeake, Joanne
Format:	Journal Article
Language:	English
Published:	England 01-02-2023
Subjects:	Cost-Benefit Analysis Critical Care Critical Illness - therapy Hospitalization Humans Patient Discharge Quality of Life critical care ARDS pulmonary rehabilitation
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Summary:	At present, clinicians aiming to support patients through the challenges after critical care have limited evidence to base interventions. Evaluate a multicentre integrated health and social care intervention for critical care survivors. A process evaluation assessed factors influencing the programme implementation. This study evaluated the impact of the Intensive Care Syndrome: Promoting Independence and Return to Employment (InS:PIRE) programme. We compared patients who attended this programme with a usual care cohort from the same time period across nine hospital sites in Scotland. The primary outcome was health-related quality of life (HRQoL) measured via the EuroQol 5-dimension 5-level instrument, at 12 months post hospital discharge. Secondary outcome measures included self-efficacy, depression, anxiety and pain. 137 patients who received the InS:PIRE intervention completed outcome measures at 12 months. In the usual care cohort, 115 patients completed the measures. The two cohorts had similar baseline demographics. After adjustment, there was a significant absolute increase in HRQoL in the intervention cohort in relation to the usual care cohort (0.12, 95% CI 0.04 to 0.20, 0.01). Patients in the InS:PIRE cohort also reported self-efficacy scores that were 7.7% higher (2.32 points higher, 95% CI 0.32 to 4.31, =0.02), fewer symptoms of depression (OR 0.38, 95% CI 0.19 to 0.76, p=0.01) and similar symptoms of anxiety (OR 0.58, 95% CI 0.30 to 1.13, =0.11). There was no significant difference in overall pain experience. Key facilitators for implementation were: integration with inpatient care, organisational engagement, flexibility to service inclusion; key barriers were: funding, staff availability and venue availability. This multicentre evaluation of a health and social care programme designed for survivors of critical illness appears to show benefit at 12 months following hospital discharge.
ISSN:	1468-3296
DOI:	10.1136/thoraxjnl-2021-218428