£2,200,000 NIHR programme grant, 2008-13, Conroy with University of Nottingham. Acute care work stream lead, developing and evaluating a transitional care model focusing on older people being discharge from acute medical units (short stay) – the RCT showed no effect, so we learnt what not to do, but also learnt much about risk stratification and implementation research, as well as bringing a clinical and academic focus to a neglected field. Findings included a very high risk of adverse outcomes (75% one or more adverse outcomes within 90 days) for older people discharged from acute hospitals within 72 hours (so ostensibly a relatively well cohort). This body of work led to the Silver Book publication and subsequent NHS service drive to develop acute geriatric services. This included our own ‘Emergency Frailty Unit, which has become a template for urgent care services for older people in organisations such as the Emergency Care Improvement Programme, and the Acute Frailty Network (>70 hospitals supported since 2015). In 2016 21% of hospitals had developed acute care for older people based on the ‘Leicester model’. Publications are in both the British Medical Journal and Age & Ageing (highest ranked clinical geriatrics journal).
£386,751 NIHR SDO, 2012-14, Conroy, Wilson, Banerjee from University of Leicester (RM62G0339). Establishing and implementing best practice to reduce unplanned admissions in those aged 85+ through system change. Evidenced the health and social care system drivers of better performance through an interview study of high vs. low performing systems (based on admission rates for people aged 85+). Findings included the importance of stable system leadership, the importance of a shared common vision, avoiding ‘pilotitis’, and an appetite for risk sharing across sectors. Influenced the development of the Acute Frailty Network and whole systems service redesign in Leicestershire, as well as the Emergency Care Improvement Programme. Publication being submitted to the Journal of Health Services Research.
£2,194,458 NIHR HTA, 2012-2021, Conroy co-applicant with University of Leicester, UK TAVI study. This RCT examines international approaches for frail older people with critical aortic stenosis. Embedded within the study is an assessment of which frailty measures best predict outcomes, which will inform the development of the Specialised Clinical Frailty Network.
£1,038,561 NIHR HSDR, 2014-17, Conroy & Martin co-applicants with University of Newcastle (RM62G0653). Acute hospital care for frail older people. This work tested geriatric care models in non-geriatric settings (e.g. surgery) and has lent important insights into the necessary conditions for such efforts to be effective. Outputs include a risk stratification process that can run automatically on hospital IT systems (engaging in implementation with NHS England, but also internationally – France, Australia, Canada). It also highlighted the challenges of embedding geriatric competencies and ‘frail-friendly’ care pathways, including the need for a ‘delivery vehicle’, such as a Breakthrough Series Collaborative: in 2018 we started the Specialised Clinical Frailty Network to do just that, working with cancer, renal, interventional cardiology, complex spinal surgery, neurosurgery and intensive care teams (n=60). Publications in Age & Ageing, and the Lancet.
£28,700 EM CLAHRC 2019-20, Conroy lead applicant. A comparison of two national approaches to identify frail older people with urgent care needs. This will address the frequent clinical question about what is the relationship between the primary care derived electronic Frailty Index and the Hospital Frailty Risk Score, and will inform the design of a national frailty registry, facilitating benchmarking and evaluation of frailty pathways nationally.
£931,653 NIHR HSDR, 2018-2021, Conroy lead applicant. Identifying models of care to improve outcomes for older people with emergency and urgent care needs. This work will use the Hospital Frailty Risk Score and whole system linked data from the Yorkshire and Humber region to develop an evidence based, patient centred Systems Dynamics model focusing upon older people with frailty and urgent care needs. The output (expected 2021) will allow systems (STPs, CCGs) to input local data into the Systems Dynamics model and determine which form of services are most likely to be clinically and cost effective, as well as providing implementation guidance.