Applying the consolidated framework for implementation research to evaluate the community rapid intervention service.

BACKGROUND: Developed in 2019, the Community Rapid Intervention Service (CRIS) is a community intervention service aiming to prevent hospital admissions. CRIS provides a response within two hours to patients with sub-acute medical needs in their usual place of residence. This evaluation aimed to identify challenges and facilitators to implementation of the service, with a view to informing future service development, optimising patient care and disseminating learning to other areas looking to implement similar services. METHODS: This study used the Consolidated Framework for Implementation Research (CFIR) as an evaluation framework. We conducted semi-structured interviews with local healthcare system leaders, clinicians that worked within the CRIS, and clinicians who interfaced with the CRIS. The CFIR was used to guide data collection and analysis. Two Community of Practice (CoP) meetings were held to gather stakeholders' perspectives of the evaluation. RESULTS: Three key themes were identified from the analysis of 13 interviews: contextual factors influencing implementation, service identity and navigating complexity. Contextual factors such the influence of the Covid 19 pandemic upon health services and the expansion of the CRIS were discussed by participants. The adaptability of the service was deemed both a facilitator and challenge of implementation. Ways to build-on and improve the existing CRIS model were suggested. CONCLUSION: This evaluation has shown that the CRIS may need to be redefined with clarity provided as to how the service interfaces with other urgent and planned care offered in acute, primary, community and social services. Structuring the evaluation around the CFIR was helpful in identifying facilitators and challenges that influenced the implementation of the CRIS.

Using the UK standards for public involvement to evaluate the public involvement sections of annual reports from NIHR managed research centres.

BACKGROUND: Within the United Kingdom (UK), the National Institute for Health and Care Research is the largest funder of health and social care research, and additionally funds research centres that support the development and delivery of research. Each year, award-holders of these research centres are required to write a report about their activities, including a summary of Patient and Public Involvement and Engagement (PPIE) activities. This study aimed to evaluate the PPIE sections of annual reports to identify best practice and challenges; this could inform future delivery of PPIE activities. METHODS: A framework documentary analysis informed by the six UK Standards for Public Involvement ('Inclusive opportunities', 'Working together', 'Support and learning', 'Communications', 'Impact' and 'Governance') was conducted on 112 reports. A quality improvement framework ('Insights') was used to evaluate quality as one of: 'Welcoming', 'Listening', 'Learning' and 'Leading'. Recommendations from this review were co-developed with stakeholders and public contributors. RESULTS: Reports documented varying levels of quality in PPIE activities which spanned across all six UK Standards. Award-holders either intended to, or were actively working towards, increasing access and inclusivity of public involvement opportunities. Methods of working with public contributors were varied, including virtual and in-person meetings. Most award-holders offered PPIE support and learning opportunities for both public contributors and staff. Some award-holders invited public contributors to co-produce communication plans relating to study materials and research findings. The impact of public involvement was described in terms of benefits to public contributors themselves, and on an organisation and project level. Many award-holders reported inviting public contributors to share decision-making within and about governance structures. CONCLUSIONS: This evaluation identified that most annual reports contained evidence of good quality PPIE practice with learning from public contributors. Using the UK Standards and Insights framework enabled exploration of the breadth and quality of PPIE activities. Recommendations include the need for a platform for centres to access and share PPIE best practice and for centres to collaborate with local and national partners to build relationships with the public through inclusive community engagement.

WHAT DID WE DO?: Within the United Kingdom (UK) the National Institute for Health and Care Research (NIHR) is the largest funder of health and social care research. The NIHR also funds research centres that support the delivery of research studies. Each year, award-holders of these research centres are required to write a report describing their activities. These reports include activities related to Patient and Public Involvement and Engagement (PPIE). We aimed to evaluate the PPIE sections of these reports to identify best practice and challenges. This could, in turn, inform and aid researchers to enhance their PPIE approaches and improve how they work with the public in research. HOW DID WE DO IT?: We looked at 112 reports using the six UK Standards for Public Involvement (these include: 'Inclusive opportunities', 'Working together', 'Support and learning', 'Communications', 'Impact' and 'Governance'). We used a quality improvement framework named 'Insights' to categorise PPIE practice into one of four levels of increasing quality: 'Welcoming', 'Listening', 'Learning' and 'Leading'. WHAT ARE THE FINDINGS?: PPIE activities, of varying quality, covered all six UK Standards. A number of award-holders either intended, or were actively working towards, increasing access and inclusivity of public involvement opportunities. Methods of working with public contributors were varied. Most award-holders offered support and learning opportunities for both PPIE members and staff. Some award-holders invited PPIE members to co-produce communication plans relating to study materials and research findings. The impact of public involvement was described in terms of benefits to PPIE members themselves, and on a project and award-holder level. Many award-holders reported inviting public contributors to share decision-making within and about governance structures. WHAT'S THE BIGGER PICTURE?: This evaluation identified that the Insights framework was useful in determining the quality of PPIE activities relating to each UK Standard. Recommendations for improving the quality of future PPIE activities were co-developed with staff from different research centres, senior leaders within the NIHR, PPIE leads and public contributors.