A mixed-methods evaluation of the ‘Closer to Home’ community intervention programme for preventing frail and elderly hospital admissions in NHS Forth Valley

  • Maria Cristina Martin

Student thesis: Doctoral Thesis


Due to increasing pressures on healthcare services resulting from unscheduled care, healthcare providers are increasingly seeking to develop alternative care pathways to reduce avoidable hospital admissions for frail and elderly people. Previous research indicates mixed results on the effectiveness of such programmes. This thesis reports the results of a mixed-methods evaluation of a community-based programme called ‘Closer to Home’, aimed at preventing hospital admissions among frail and elderly people living in the NHS Forth Valley health board in Scotland.The evaluation sought to 1) understand the structures and operational processes of the programme, 2) identify whether participation was associated with reduced hospital activity outcomes and 3) understand the benefits and barriers to implementation. The methods used in the evaluation included process mapping in an exploratory research phase to understand the programme processes, a scoping literature review to identify key features of previous studies evaluating community-based admission avoidance interventions, a quantitative retrospective cohort study evaluating the programme’s effect on hospital activity outcomes and a qualitative study using Normalisation Process Theory (NPT) to analyse stakeholders’ perspectives on the programme implementation.This research found no evidence to support the hypothesis that the programme is associated with reduced hospital activity, but it also highlighted the difficulty in objectively evaluating such programmes due to non-randomised roll-out, characteristic of community based interventions. Healthcare professionals however, perceived clear benefits in the provision of ‘Closer to Home’ services extending beyond merely preventing hospital admissions.This research provides the first comprehensive mixed-methods evaluation of a hospital admission avoidance programme within NHS Forth Valley. It is clear that ‘Closer to Home’ services have a key role to play in the local healthcare ecosystem but that the lack of full integration into the healthcare system prevented them from reaching their full potential and that the assessment of such services against healthcare resource use provides a limited view of the associated benefits, highlighting the need to expand the focus of evaluation of such programmes on outcome measures that capture wider impacts.
Date of Award20 Apr 2023
Original languageEnglish
Awarding Institution
  • University Of Strathclyde
SponsorsUniversity of Strathclyde
SupervisorMatt-Mouley Bouamrane (Supervisor) & Kimberley Kavanagh (Supervisor)

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