The HOME study - Michael Sharpe s CBT for the elderly

This PPM rubbish is another complete waste of time and money.

From a report done by age uk:
Problems with Social Care
A major barrier to achieving safe and rapid discharge from hospital is the availability of social care support.
 Just under 40% of delays are attributed to the lack of availability of social care support and/or assessment funding.
 Funding for older people’s social care reduced by £0.66 billion between 2005/06 and 2014/15.
 The number of people receiving publicly funded support has fallen by around 377,000 from 1.2 million at the start of the period to just over 850,000 by 2014/152.
 National Audit Office Report on Discharging Older People from Hospital (2016) states a 31% increase in delayed transfers of care.
 Number of days spent waiting for a package of home care have more than doubled between 2013 and 2015, from 89,000 to 182,000) as has waiting for a nursing home placement or availability (which increased by 63%)”.
 In 2011 to 2013, recipients of local authority funded home care declined by 15%.
 The NAO estimate that overall delays are responsible for £820 million of avoidable costs to the NHS making.
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full report here
https://www.ageuk.org.uk/globalasse...ischarge_from_hospital_briefing_june_2016.pdf
 
Yes, what is needed is the appropriate social care assessment and the necessary practical support put in place for the person returning home. How can this 'trial' not end up being confounded by other projects that are increasingly being rolled out by various NHS trusts and local authorities working together?

An example is the project happening in my area:

https://www.tsft.nhs.uk/about-your-...-reduced-thanks-to-new-home-first-initiative/
 
Sly Saint said:
Michael Sharpe
MA, MB BChir, MD, FRCP, FRCPEdin, FRCPsych
Professor of Psychological Medicine

  • Fellow of Saint Cross College, Oxford.
  • Honorary Consultant in Psychological Medicine and Trust Lead in Psychological Medicine at Oxford University Hospitals NHS Foundation Trust and advisor to Oxford Health NHS Foundation Trust.
  • Honorary Professor, University of Edinburgh.
  • NIHR Senior Investigator
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Michael Sharpe is NIHR Senior Investigator. Does this have something to do with the appalling standard of NIHR funded "research"?
 
Relative worked in orthopaedics. Some patients were on the ward for months, 9 or more not being unusual, while they waited to be assigned a social worker. Once the social worker was involved the process went quickly but by then people who came in with mild dementia had become institutionalised. They would be transferred to a care home with programmes to keep them active and alert but it was too late.

So how would CBT help them?
 
From what I gather from looking at the protocol and associated papers, this isn't so much of an intervention as a brief psychiatric assessment (3-5 mins per patient, according to Desan et al 2011) and subsequent interdisciplinary collaboration. If that can really reduce inpatient stay and improve outcomes, then good luck to them - seems like a great idea!

Other papers mentioned are this one - Miani et al 2014 and Sledge et al 2015.

The main problem with the protocol though is that it is very light on any detail about what exactly their intervention is. Seems to be mostly a data-gathering exercise. Also seems difficult to control adequately - but I know 3 of the statisticians involved, so hopefully they've targetted all that.
 
Sly Saint said:
protocol for the HOME study now published pdf here:
https://link.springer.com/epdf/10.1186/s13063-019-3502-5?shared_access_token=kKR11aoSLtkBjA0nbDFrWW_BpE1tBhCbnbw3BuzI2RPoOrDaODCRPsFTJ102iBRHzzgPihI_9ZFKGH9yyKIN-4vKqWgzB8ieeW71_QSfLrO9G86jQ1JYmcod-63Sy54EeV-BBl-w6xaOlj2KTyaLnHG3iqnS_ErF7pvDe5s4mL0=








published here:
https://trialsjournal.biomedcentral.com/articles/10.1186/s13063-019-3502-5

would be interesting to see the 'service manual'
eta: not sure what to think about the last secondary outcome on the list
"death in the year post-randomisation"; but I'm sure they'd just say it's 'perfectly normal'
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So.... basically this is medicine-by-MBA? Just throwing corporate-speak buzzwords and random positive-sounding fluff? Also stop it with the dumb "holisting" and "broad" psychosocial approach. It's the most reductive, narrow model of medicine out there as it strictly focuses on imaginary psychology that is untestable, unquantifiable and unfalsifiable.

using a biopsychosocial approach to identify all problems
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Apparently our psychosocial wizards have been hiding the fact that they invented the medical tricorder. Or a magic wand. Or maybe it's Parker's hand-feels?

I'm sorry that's not how any of this works. You can't just claim "this made-up thing will identify all problems". Those are precisely the kinds of claims that make pseudoscience laughable and it doesn't work any better here. You don't even need to spend more than 30 seconds reflecting on this to understand that it's complete BS. Ridiculous.
 
Mithriel said:
So how would CBT help them?
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My guess is giving consent to being discharged quicker, despite there being no support available afterward.

That's the psychosocial model in a nutshell: don't bother actually helping people, just convince them that you did and report that using a BS questionnaire and some statistical hand-waving. It's way more expensive overall but you can point at your own budget being slightly lower as proof of success. Externalities? What's that? No, see, if you only look at this account right here it looks cheaper. Great success!
 
It's been published if anyones interested
The HOME Study: Statistical and economic analysis plan for a randomised controlled trial comparing the addition of Proactive Psychological Medicine to usual care, with usual care alone, on the time spent in hospital by older acute hospital inpatients

Abstract
Background
Prolonged acute hospital stays are a problem for older people and for health services. Failure to effectively manage the psychological and social aspects of illness is an important cause of prolonged hospital stay. Proactive Psychological Medicine (PPM) is a new way of providing psychiatry services to medical wards which is proactive, focussed, intensive and integrated with medical care. The primary aim of PPM is to reduce the time older people spend in hospital because of unmanaged psychological and social problems. The HOME Study will test the effectiveness and cost-effectiveness of PPM.

Methods/design
The study is a two-arm, parallel-group, randomised, controlled superiority trial with linked health economic analysis and an embedded process evaluation. The target population is people aged 65 years and older admitted to acute hospitals. Participants will be randomly allocated to either usual care plus PPM or usual care alone. The primary outcome is the number of days spent as an inpatient in a general hospital in the month following randomisation. Secondary outcomes include quality of life, cognitive function, independent functioning, symptoms of anxiety and depression, and experience of hospital stay. The cost-effectiveness of usual care plus PPM compared with usual care alone will be assessed using quality-adjusted life-years as an outcome as well as costs from the NHS perspective.

Discussion
This update to the published trial protocol gives a detailed plan of the statistical and economic analysis of The HOME Study.
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https://trialsjournal.biomedcentral.com/articles/10.1186/s13063-020-04256-8
 
I think he said they've recruited two and a half thousand patients in Medical Wards (where you have to be very sick to be admitted) and most of them were cognitively impaired or had dementia.

So how could they give informed consent? Oh, of course, their relatives would have given it. They don't know about MS and his spurious "science".

Just my personal thoughts about myself - I'm sad that I'm older than MS, I'd love to see him in the position of those older people who he is taking advantage of to keep his career going. Well, I suppose it's something to keep me going till 100 for the chance! :rolleyes:
 
Jees, just noticed that the Older People were only over 65. No hope for me then - over 70. Though I don't think my kids would leave me to the mercy of any trial run by or bigged up by MS - think I educated them about him as well as SW.
 
Sly Saint said:
It's been published if anyones interested
The HOME Study: Statistical and economic analysis plan for a randomised controlled trial comparing the addition of Proactive Psychological Medicine to usual care, with usual care alone, on the time spent in hospital by older acute hospital inpatients



https://trialsjournal.biomedcentral.com/articles/10.1186/s13063-020-04256-8
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Changing protocol mid-trial again? I mean of course, this is typical of psychosomatic research. I though this practice was not possible anymore? The AllTrials thing? I'm sure they already have their exception lined up. I guess some people are just special like that and can do whatever they want.

Found this in reviewer comments:
Only one small problems, could the authors give more information about the Proactive Psychological Medicine and how to implement it??
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That is indeed one small problem. You know, what is this thing even made of? That's just minor stylistic stuff. That same reviewer rated the manuscript exceptional. Hard to argue this isn't style over substance when a review finds it exceptional yet casually asks "by the way, what is this thing you're doing?"

Whew another reviewer found it important focus on the definition of ethnicity, which is clearly a very substantial element here.
The main aim of the study is to determine whether adding PPM to usual care affects the time (in days) spent as an acute hospital inpatient in the 30 days post randomisation. Any time spent as an inpatient on a particular calendar date will be counted as a day in hospital.
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I'm sure this will have no impact whatsoever in the "intervention" trying to convince patients that reducing their stay will lead to better outcomes. Actually this pretty much guarantees that this is the main focus of the "intervention". Hospital stay is very expensive. This will obviously lead to the appearance of savings, as long as you don't count externalities, which of course won't be counted. If you don't count it doesn't exist, right?

Reminder that the very first step of this magical treatment relies on magical abilities that do not exist in this universe:
Early proactive assessment of newly admitted patients using a biopsychosocial approach to identify all the patient’s problems, including psychiatric illness
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They will identify ALL the patient's problems. Just like that. Why did no one think of this before we could save so much money if we just did that all the time. You just need gumption, I guess, call it like it is and gut-feeling and all of that.
The creation of a systematic management plan to address those problems that pose potential barriers to prompt discharge from hospital
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Yup. If you make the end-point the main target of intervention you basically nullify the experiment because then the entire focus of the experiment will be to influence the end-point, but that's just a small detail.
allowing for 5% loss to follow-up
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Not sure I've ever seen a BPS experiment with less than 15% loss to follow-up.

This is clearly a cost-saving program. We already know that denying medical care to sick people is cheaper, but someone has to fabricate a convincing argument I guess. It's just a modest proposal, after all.
 
Esther12 said:
What changes from the protocol were there? The primary outcome looks the same as the trial registration but that was all I checked.
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The outcome analysis? It's really not clear what changed since there is no change tracking feature but what I understood is that they added the statistical analysis plan and some more details of the "intervention". It's frankly hard to follow the timeline. And from the reviewer comments it seems they just added the details about what the "intervention" is at all. In a trial that seems under way but even that is unclear since it speaks of recruiting but this an experiment with a rolling recruitment during hospitalization, which can't be banked any more than pregnancies can.
 
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