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Original research
Did the Acute Frailty Network improve outcomes for older people living with frailty? A staggered difference-in-difference panel event study
  1. Andrew Street1,
  2. Laia Maynou1,2,3,
  3. Simon Conroy4
  1. 1Department of Health Policy, The London School of Economics and Political Science, London, UK
  2. 2Deparment of Econometrics, Statistics and Applied Economics, Universitat de Barcelona, Barcelona, Spain
  3. 3Center for Research in Health and Economics (CRES), Universitat Pompeu Fabra, Barcelona, Spain
  4. 4MRC Unit for Lifelong Health and Ageing, University College London, London, UK
  1. Correspondence to Professor Andrew Street, Department of Health Policy, The London School of Economics and Political Science, London WC2A2AE, UK; A.Street{at}lse.ac.uk

Abstract

Objectives To evaluate whether the Acute Frailty Network (AFN) was more effective than usual practice in supporting older people living with frailty to return home from hospital sooner and healthier.

Design Staggered difference-in-difference panel event study allowing for differential effects across intervention cohorts.

Setting All English National Health Service (NHS) acute hospital sites.

Participants All 1 410 427 NHS patients aged 75+ with high frailty risk who had an emergency hospital admission to acute, general or geriatric medicine departments between 1 January 2012 and 31 March 2019.

Intervention Membership of the AFN, a quality improvement collaborative designed to support acute hospitals in England deliver evidence-based care for older people with frailty. 66 hospital sites joined the AFN in six sequential cohorts, the first starting in January 2015, the sixth in May 2018. Usual care was delivered in the remaining 248 control sites.

Main outcome measures Length of hospital stay, in-hospital mortality, institutionalisation, hospital readmission.

Results No significant effects of AFN membership were found for any of the four outcomes nor were there significant effects for any individual cohort.

Conclusions To realise its aims, the AFN might need to develop better resourced intervention and implementation strategies.

  • healthcare quality improvement
  • evaluation methodology
  • health policy

Data availability statement

Data may be obtained from a third party and are not publicly available. This paper was produced using Hospital Episode Statistics provided by NHS Digital under Data Sharing Agreement NIC-354497-V2J9P. This paper has been screened to ensure no confidential information is revealed.

http://dx.doi.org/10.1136/bmjqs-2022-015832

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    Data availability statement

    Data may be obtained from a third party and are not publicly available. This paper was produced using Hospital Episode Statistics provided by NHS Digital under Data Sharing Agreement NIC-354497-V2J9P. This paper has been screened to ensure no confidential information is revealed.

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    Footnotes

    • Contributors AS, LM and SC conceived and conceptualised the study. AS and LM developed the methodological approach and accessed and verified the data. LM performed the analyses and AS wrote the first draft of the manuscript. All authors contributed to interpretation of data and to critical revision of the manuscript and approved the final version. AS is the guarantor of the study.

    • Funding Funding was provided by NHS Elect.

    • Competing interests None declared.

    • Provenance and peer review Not commissioned; externally peer reviewed.

    • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.

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