Use of a digital application to enhance communication and triage between care homes and National Health Service community services in the United Kingdom: a qualitative evaluation

Abstract

Recent years have seen a rise in digital interventions to improve coordination between care homes and NHS services, supporting remote sharing of data on the health of care home residents. Such interventions were key components in the response to the COVID-19 pandemic. This paper presents findings from the qualitative component of an evaluation of an implementation of the HealthCall Digital Care Homes application, across sites in northern England. The implementation commenced prior to the pandemic and continued throughout.Semi-structured, qualitative interviews were held with stakeholders. Interviews were conducted remotely (October 2020 -June 2021). Data were analysed via a reflexive thematic analysis then mapped against Normalization Process Theory (NPT) constructs (coherence, collective action, cognitive participation, and reflexive monitoring) providing a framework to assess implementation success.Thirty-five participants were recruited: 16 care home staff, six NHS community nurses, five relatives of care home residents, four HealthCall team members, three care home residents, and one local authority commissioner. Despite facing challenges such as apprehension towards digital technology among care home staff, the application was viewed positively across stakeholder groups. The HealthCall team maintained formal and informal feedback loop with stakeholders. This resulted in revisions to the intervention and implementation. Appropriate training and problem solving from the HealthCall team and buy-in from care home and NHS staff were key to achieving success across NPT constructs.While this implementation appears broadly successful, establishing rapport and maintaining ongoing support requires significant time, financial backing, and the right individuals in place across stakeholder groups to drive implementation and intervention evolution. The digital literacy of care home staff requires encouragement to enhance their readiness for digital interventions. The COVID-19 pandemic has pushed this agenda forward. Problems with stability across the workforce within care homes need to be addressed to avoid skill loss and support embeddedness of digital interventions.What is known about this topic?Improving healthcare delivery in UK care homes is a health policy priority.Digital interventions designed to enhance the referral process between care homes and NHS services and improve the healthcare delivery in care homes have become increasingly common in the UK. The HealthCall Digital Care Homes application is one such intervention.These interventions and their implementations require evaluation to ensure that they operate as intended, function coherently and are considered appropriate and legitimate to the care home setting.What this paper adds?The HealthCall Digital Care Homes app is a feasible, appropriate and legitimate intervention for referral, triage and health care support for non-urgent health care needs of care home residents.The ongoing involvement of end users in further developing the intervention, and the level of monitoring and support provided by the implementation team appears to be key to the implementation’s success.The digital preparedness of UK care homes is limited. Ensuring that care homes are digitally enabled, with a digitally literate workforce, should be a policy and research priority.

The impact of digital technology in care homes on unplanned secondary care usage and associated costs

“…Improved communication between care home staff and the NHS, including NHS community nursing services, provides greater opportunity for joint decision making on the delivery of optimal care for residents, which we found led to a reduction in ED attendances and hospital admission. The associated qualitative study undertaken alongside this quantitative analysis [ 5 ] found that additional input from a multi-disciplinary team improves the confidence of care home staff by providing greater monitoring, and earlier identification of deterioration. This in turn may impact on the reduced length of hospital stay due to earlier detection and prompt management of illness.…”

“…One of the solutions provided is the Health Call Digital Care Homes Application (app), designed for use by staff in care homes [ 3 ]. A primary goal of the app is to reduce avoidable secondary care for the residents in the homes, through timely access to clinical advice ( Box 1 ) [ 4 , 5 ].…”

The Impact of Digital Technology in Care Homes on Unplanned Secondary Care Usage and Associated Costs

“…Impact of Health Call on non-zero costs and the probability of zero monthly costs in the form of odds ratio (OR) for zero cost models and relative risks for the magnitude of costs model (RR Improved communication between care home staff and the NHS, including NHS community nursing services, provides greater opportunity for joint decision making on the delivery of optimal care for residents, which we found led to a reduction in ED attendances and hospital admission. The associated qualitative study undertaken alongside this quantitative analysis [5] found that additional input from a multi-disciplinary team improves the confidence of care home staff by providing greater monitoring, and earlier identification of deterioration. This in turn may impact on the reduced length of hospital stay due to earlier detection and prompt management of illness.…”