This project asks what the impact is of the Acute Frailty Network on mortality, length of stay (LoS), institutionalisation and 30-day readmission for older people with frailty? Membership of the AFN involves 1). the adoption and spread of best practice in line with the 10 AFN principles to support the delivery of Comprehensive Geriatric Assessment (CGA) for older people living with frailty who have acute care needs, and 2). support from national clinical and improvement experts. Members are hospital sites (rather than trusts), so these will be the unit of observation. Members have been enrolled over time (from January 2015) in eight separate cohorts, and site code and membership date are available for each member.
The primary outcomes of interest are: in-hospital mortality, hospital LoS, institutionalism, unplanned readmissions within 30-days of discharge
The aim of the AFN is to support older people living with frailty return home from hospital sooner and healthier. Early identification of those with frailty and CGA support may reduce mortality, reduce LoS in hospital, and help people return to their own homes rather than a care or residential home.
There is a possibility that reductions in LoS may mean that patients are discharged prematurely, in a less stable condition. If so, they may be more at risk of being re-admitted to hospital.
This study employs the Hospital Episodes Statistics from 2010 to 2020, thus starting some five years prior to the first cohort joining the AFN. This time period should also allow for sufficient follow-up time to observe any effects, some anecdotes suggesting it takes 9 months to see any service improvements deriving from membership. It identifies older people (75+) with urgent care needs presenting to acute hospitals. These are defined as patients with high frailty risk (HFRS=high) admitted as non-electives to either acute, general or geriatric medicine.