The Acute Frailty Network: experiences from a whole-systems quality improvement collaborative for acutely ill older patients in the English NHS

Older people form a growing proportion and volume of those accessing urgent care, much of which is provided by non-specialists in geriatric medicine. Non-specific presentations, multiple comorbidities and functional decline make assessment and management of this cohort challenging. In this article we describe the approach and methods of the Acute Frailty Network (AFN), a national quality improvement collaborative designed to support acute hospitals in England to deliver evidence-based care for older people with frailty. We report on 3 years’ experience of whole-systems quality improvement through the network. Using local case studies, we illustrate initiatives through which AFN hospitals improved services and outcomes for older people with frailty and urgent care needs. We describe returns on investment and sustainability of implementation, and reflect on future directions for the AFN

Participant Characteristics and Scores (<i>n</i> = 1,467).

<p>Participant Characteristics and Scores (<i>n</i> = 1,467).</p

Indirect Effects on Mental Health Outcomes in Multiple-Mediator Models.

<p>Indirect Effects on Mental Health Outcomes in Multiple-Mediator Models.</p

Direct Effects (<i>c</i>’ path) and Psychosocial Factor-Mediated Indirect Effects (<i>a</i> and <i>b</i> paths) of the Social Environment on Mental Health in African Americans.

<p>(A) Perceived stress and depressive symptoms, but not discrimination, jointly mediated the relationship between SSS-community and mental health (Effect = 0.643, <i>SE</i> = 0.128, 95% <i>CI</i>: 0.397, 0.891). (B) Perceived stress, depressive symptoms and discrimination jointly mediated the relationship between SSS-US and mental health (Effect = 0.790, <i>SE</i> = 0.140, 95% <i>CI</i>: 0.519, 1.068). (C) Perceived stress, depressive symptoms and discrimination jointly mediated the relationship between social support and mental health (Effect = 0.476, <i>SE</i> = 0.037, 95% <i>CI</i>: 0.403, 0.549). SE = standard error; SSS = subjective social status. *<i>P</i> < .05; **<i>P</i> < .01.</p

Theorizing Ontology

University of California Santa Cruz (UCSC) Genome browser view (chr6:22308200–22348900) showing the position of single nucleotide polymorphisms (SNPs) rs9356811, rs10946546, rs9358531, rs9393273, rs12525289, rs12199382 and rs12524161. (DOC 261 kb

MOESM1 of Enhancing disease surveillance with novel data streams: challenges and opportunities

Supplemental table (pdf

Additional file 10: Figure S2. of A comprehensive evaluation of interaction between genetic variants and use of menopausal hormone therapy on mammographic density

University of California Santa Cruz (UCSC) Genome browser view (chr6:22308200–22348900) showing the position of single nucleotide polymorphisms (SNPs) rs9356811, rs10946546, rs9358531, rs9393273, rs12525289, rs12199382 and rs12524161. (DOC 261 kb