Bojke, Laura

Fox, Aimee

Hinde, Sebastian

Richardson, Gerry

White Rose Research Online

This is a repository copy of Evaluation of an Urgent and Emergency Liaison Mental HealthService in an Acute Hospital Using an Interrupted Time Series Analysis.White Rose Research Online URL for this paper:https://eprints.whiterose.ac.uk/146967/Conference or Workshop Item:Fox, Aimee orcid.org/0000-0001-6944-7554, Bojke, Laura orcid.org/0000-0001-7921-9109,Richardson, Gerry orcid.org/0000-0002-2360-4566 et al. (1 more author) (2019) Evaluation of an Urgent and Emergency Liaison Mental Health Service in an Acute Hospital Using an Interrupted Time Series Analysis. In: Health Services Research UK, 04-05 Jul 2018. (Unpublished) eprints@whiterose.ac.ukhttps://eprints.whiterose.ac.uk/Reuse Items deposited in White Rose Research Online are protected by copyright, with all rights reserved unless indicated otherwise. They may be downloaded and/or printed for private study, or other acts as permitted by national copyright laws. 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Evaluation of an Urgent and Emergency Liaison Mental Health Service in an Acute Hospital Using an Interrupted Time Series AnalysisAimée Fox1, Laura Bojke1, Gerry Richardson1, Sebastian Hinde1aimee.fox@York.ac.uk 1 Centre for Health Economics, University of YorkBACKGROUND NHS England has made available transformation funding to improve liaison services ingeneral hospitals with 24/7 Emergency Departments (1). This model of 24/7 urgent and emergency mental health care is referred to as the Core24model which provides response to patients who present at EDs within 1 hour and to allurgent ward referrals within 24 hours (1). Evidence has shown that benefits of these models of care are anticipated at both thepatient and provider level in terms of reduced inappropriate hospital admissions,improved discharge planning, reduced length of hospital stay, reduced re-attendances atEDs and better support due to clearer referral routes for patients and training and supportfor staff (2,3). Recent evaluations of similar liaison models have been retrospective in nature so a RCTwas impractical and it was not possible to include a control. Authors of the recentevaluations have reported difficulty when trying to overcome this limitation in theirstatistical analysis (2,3). An interrupted time-series (ITSA) is increasingly being used as a more flexible design to beconsidered for the evaluation of health interventions (4).RESULTSThis research was funded by the NIHR CLAHRC Yorkshire and Humber (NIHR CLAHRC YH). www.clahrc-yh.nihr.ac.uk.  The views expressed are those of the author(s), and not necessarily those of the NHS, the NIHR or the Department of Health and Social Care.Outcome Intercept (β0) Baseline trend (β1)Change in level after Core24 (β2)Change in trend after Core24 (β3)Postrend outputNumber of ED attendances60.31*** 0.03 12.49** -0.93** -0.91***ED total weekly costs£9346.93*** £10.36** £2425.01*** -£162.86** -£152.50**Average LOS 12.19*** -0.02 3.44** -0.20** -0.22**LOS average weekly costs£3062.13*** -£5.61 £901.64** -£44.49** -£50.10**OBJECTIVE Apply an ITSA to evaluate the cost-effectiveness of a CORE24 mental healthliaison team that is being launched in a hospital in North England, with a primaryfocus on ED attendances and length of stay (LOS).Apr. 2015-Mar.2017Pre-Core24 periodApr. 2017 – Oct. 2017Core24 funding secured in April and service began to change. Core24 officially launched in Oct. 2017Post-Core24 periodNov. 2017-Mar. 2018 Evaluation performedApr. 2018100% Recruitment expected for Core24EVALUATION TIMELINEDATA AND METHODS Individual level anonymised data pertaining to patients diagnosed with a mentalhealth condition (ICD-10 code with an F prefix). Outcome variables: Number of ED attendances and subsequent costs andaverage length of stay (LOS) and costs. Costs were estimated using the Healthcare Resource Group (HRG) codesprovided for each patient in the data to retrieve the relevant cost in the NHSreference costs Statistical analyses was conducted using Stata 15. The itsa command was used torun the interrupted time series analysis. Data were aggregated in weeks with 134 time intervals generated in total: 105pre-Core24, 1 week during the intervention and 28 weeks post-Core24.Figure 1: Impact of Core24 on ED costsFigure 2: Impact of Core24 on LOS costsLIMITATIONS Evaluation of an incomplete service Lack of post-intervention data Could not adjust for patient demographics in ITSA modelREFERENCES(1) NICE. Achieving Better Access to 24/7 Urgent and Emergency Mental Health Care – Part 2: Implementingthe Evidence-based Treatment Pathway for Urgent and Emergency Liaison Mental Health Services forAdults and Older Adults – Guidance. 2016.(2) Tadros G, Salama R, Kingston P, Mustafa N. Impact of an integrated rapid response psychiatric liaisonteam on quality improvement and cost savings: the Birmingham RAID model. . The Psychiatrist.2013;37(1):4-10(3) Becker L, Saunders R, Hardy R, Pilling S. The RAID model of liaison psychiatry: Report on the evaluationof four pilot service in east London. UCL, 2016.(4) Linden A. Conducting interrupted time-series analysis for single- and multiple-group comparisons. TheStata Journal. 2015;15(2):480-500.Table 1: ITSA Statistical OutputSample 8104 patients with a mental health condition attended the ED and 1803patients with a mental health condition were admitted to the hospital duringthe study period. Average age of ED patients was 34 years and average age of inpatients was 65years.Impact of Core24 on ED costs In the first week of the intervention (Figure 1), there was a significant increasein ED costs (β2, P<0.01, CI = £1229.86, £3620.17). Followed by a significant decrease in weekly costs, relative to the pre-intervention trend (β3, P<0.05, CI = -£253.13, -£72.58). Results predict that Core24 began to reduce total ED costs at week 121; 15weeks after Core24 was secured.Impact of Core24 on LOS costs During the first week of Core24 (Figure 2), there was a significant increase inthe average weekly LOS cost (β2, P<0.05, CI = £28.03, £1775.25). Followed by a significant decrease in LOS costs, relative to the pre-interventiontrend (β3, P<0.05, CI = -£82.40, £-6.57). Results predict that Core24 began to reduce average LOS costs at week 127; 21weeks after Core24 funding was secured.__________________________________________________________________________________________________________________STRENGTHS Robust methodology Repeatability of analysis Captured largest proportion ofpatients targeted by Core24CONCLUSION This evaluation provides evidence that since the launch of the Core24 mentalhealth liaison team, the North England hospital has experienced a reduction inED attendances, a decline in ED costs, a significant reduction in LOS and asignificant decrease in LOS

Evaluation of an Urgent and Emergency Liaison Mental Health Service in an Acute Hospital Using an Interrupted Time Series Analysis

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Evaluation of an Urgent and Emergency Liaison Mental Health Service in an Acute Hospital Using an Interrupted Time Series Analysis

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