Every year, 40,000 people in the UK are hospitalised with acute pancreatitis, yet one in three will be readmitted within 30 days because no standardised post-discharge care exists. This matters because patients currently leave hospital without clear guidance or support, leaving them vulnerable to complications, mental health problems, and repeated hospital visits. The problem was identified as a top priority by the James Lind Alliance, but no evidence-based pathway has been developed to address it. The research team will build that pathway from scratch. They will survey clinicians and patients to define what "good" care looks like, interview 30 recently discharged patients about their experiences, and question healthcare professionals about current practice. A cohort of 1,020 patients will be tracked for six months to identify who is most likely to need further care, using hospital records and regular mental health questionnaires. Finally, patients, clinicians, and commissioners will co-produce practical interventions, assessed using the APEASE tool. If successful, this work will produce the first evidence-based, co-designed care pathway for acute pancreatitis after hospital discharge. That could reduce readmissions, improve mental health outcomes, and save the health system significant costs.
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Research question What care is offered to and accessed by people with AP after discharge and what are the opportunities to improve this? Background Acute pancreatitis (AP) affects 40,000 people in the UK each year, costing $2 billion globally. AP causes pain, nausea & vomiting, and in severe cases, death. There are no in-depth recommendations for post-discharge care. 30% of people with AP will be readmitted to hospital within 30 days, and many will develop mental health problems. Patients do not feel they have adequate support after discharge, and this may put them at risk of adverse outcomes and additional healthcare utilisation. This has been highlighted as a James Lind Alliance priority. Objectives: 1. Develop conceptual framework for a ‘gold-standard’ post-hospital discharge pathway (WP1) 2. Explore patient experience of post-hospital discharge care (WP2) 3. Explore clinician approaches to post-discharge care (WP3) 4. Identify groups at highest risk of use of health care services(WP2&4) 5. Propose interventions to improve post-discharge care (WP5) 6. Co-produce interventions for post-discharge care pathways (WP5) Methods We will undertake five work packages (WP) to meet these objectives: WP1: A short online survey of clinicians, commissioners and patients to understand the characteristics of a ‘gold standard’ post-discharge care pathway. Content analysis will inform a framework of ‘good’ characteristics. WP2: We will interview up to 30 people who are between 3 to 6 months following discharge after an episode of AP. Interviews will be undertaken virtually or by telephone, and a translator will be available if necessary. Interviews will explore experiences of post-discharge care, and what support they would have liked to have. WP3: We will interview a range of healthcare professionals to explore their attitudes to post-discharge care. This will explore their current practice, and what they would like to implement to improve care. This will include primary and secondary care representation. WP4: A cohort of 1020 participants who are being discharged following an AP admission will be recruited and followed-up for 6 months. Baseline characteristics including demographics, mental health diagnosis and alcohol use will be captured. Regular follow-up with EQ-5D, GAD7 & PHQ-9 will be undertaken. We will survey use of health care in the follow-up period and undertake a HES linkage study. Models will be developed to identify those at highest risk of healthcare use. WP5: A co-production exercise including patients, clinicians, and commissioners will be undertaken to propose pathway interventions to improve outcomes following discharge. Interventions will be assessed using the APEASE tool. Public and patient involvement is embedded in the study. Efforts have been made to maximise inclusivity, through translation services, animations to support recruitment, and engagement of experts who work with people who misuse alcohol. Timeline: Start: June 25 Set up: M1 –6 WP1: M7-9 WP2: Recruitment M9-14, Analysis M15-16 WP3: Recruitment M16-M21, Analysis M22-24 WP4: Recruitment M7-18, Follow-up M19-24,HES linkage M25-27, Analysis M28-29 WP5: M30 Closeout: M31-32 Total time 32 months Anticipated impact and dissemination: We will establish an Impact and Implementation Advisory Board to help us communicate findings with key stakeholders including specialist societies and commissioners, translating findings into better post-discharge care.
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