Investigating innovations in outpatient services: a mixed-methods rapid evaluation

Area of Science:

• Health Services Research
• Outpatient Care Innovation
• Healthcare Management

Background:

• Outpatient services are exploring innovations to improve care management and reduce appointment frequency.
• Patient-Initiated Follow-Up (PIFU) is an understudied innovation enabling patients to book appointments based on need, deviating from standard schedules.

Purpose of the Study:

• To identify outpatient innovations implemented in England's National Health Service (NHS) using national hospital data.
• To conduct a rapid mixed-methods evaluation of PIFU's implementation and impact within the NHS.

Main Methods:

• A four-workstream approach including a scoping review, indicator saturation for data analysis, and hospital interviews.
• A mixed-methods evaluation of PIFU involving evidence review, interviews with 36 clinical/operational staff and 4 patients across 5 NHS trusts, and a workshop with 13 NHS trusts.
• Analysis of national and local data, supplemented by the development of an evaluation guide.

Main Results:

• Indicator saturation identified nine services with significant changes in follow-up ratios; interviews revealed varied implementation models and success factors (clinical condition, IT, staff capacity).
• National data analysis showed an association between increased PIFU use and lower outpatient attendance in 15 specialties, and higher attendance in 7 specialties.
• Four specialties demonstrated fewer emergency department visits with increased PIFU rates; staff and patients viewed PIFU positively, though impacts on workload varied.

Conclusions:

• PIFU is perceived positively by staff and patients, offering insights into national outpatient transformation policy and local practice.
• The study highlights variability in PIFU implementation, patient selection, monitoring, and discharge processes across different settings.
• Uncertainty remains regarding PIFU's impact on individual outcomes, health inequalities, patient experience, workload, and capacity, necessitating local evaluations.