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The AD-CARE study consists of three different work packages that will deliver a comprehensive report on the current value of ADUs, and recommendations about service models which will be of high value to stakeholders in acute care.
Study 1: National ADU mapping and categorisation
We will build on our national crisis team survey to obtain more data on all ADUs in England. We will use existing contacts to collect information on service models including treatments offered, staffing, service user case mix and throughput, and routine outcomes (e.g. readmissions to the acute pathway and service user satisfaction).
Study 2: ADU Case studies using mixed methods
We will select 5 ADUs with contrasting service models. These will be mixed methods case studies utilising routine administrative data from information teams, quantitative and qualitative assessments to determine user pathways in and out of the ADU, user/family experience, clinician and service user rated outcome measures and types of interventions received in the ADU or referred to for ongoing care. We will select ADUs who sign up to establishing routine outcome data collection to create an ADU minimum dataset for AD-CARE.
Study 2.1 Comparative cohort studies of people who have had a mental health crisis, comparing people who receive ADU care and those who do not
We will recruit an ADU cohort of 80 people attending each of the five case study ADUs for more than 1 week, and a comparison cohort of 80 similar people discharged from crisis team care in the same Trust/locality without ADU input. Total sample: 400 per arm= 800. Main outcomes are readmission to acute pathway at 6 months and satisfaction with services provided.
Study 2.2 Qualitative interviews (undertaken by service user researchers) with 25 users, 15 carers and 15 stakeholder staff focusing on the value of the ADU in the acute pathway, ADU merits and problems and likely impact on admission, social exclusion and engagement with other parts of the community post-crisis. We will use semi-structured interviews with a topic guide designed and refined by our Service User Research Group.
Study 3: Impact of enhanced crisis services on acute admissions nationally
We will use the Mental Health Minimum Dataset (MHMDS) and Hospital Episodes Statistics (HES) to assess admission rates to acute psychiatric units, as well as rates of compulsory admissions in a one year period. We will divide the country into areas with ADUs/enhanced crisis care and areas without. We will then model whether areas with a crisis system enhanced by ADUs have fewer admissions than places without.
Where the data comes from
Data in the MHMDS and the HES comes from routinely collected information each time someone uses an NHS mental health service.
What data is collected
The data collected includes things like diagnoses and treatments, as well as the different types of services used, and information like age, gender, and ethnicity. None of the information identifies individuals, e.g. the data set does not include names, addresses, or NHS number. Only the first part of each person's post code is in the data set (e.g. SW16), and only their month and year of birth (e.g. January 1979).
How the data is linked
The information in these databases is held by NHS Digital, and they will link information using a unique ID number for each person.
Purpose of the data
The reason for using these very large data sets is so that we can test whether people in areas that have enhanced crisis care do better than people in areas without this type of service.
Where the data is kept
The data is kept by the 'Data Controller', University College London (UCL) in a very secure database at UCL called the Data Safe Haven, which is certified to the ISO27001 information security standard and conforms to NHS Digital's Information Governance Toolkit. This means that there are very high security standards in place.
Who can see the data
The only people who will have access to the data are the 'Data Processors', who are the Chief Investigator of the study and the study statistician. They will be able to access the Data Safe Haven to run analyses on the data, and the results of the analyses will be shared with the wider study team, and may be published in academic papers. No actual data will be shared or published.
How long is the data kept for
The data will only be kept for the duration of the study.
Contact us
The AD-CARE study team can be contacted with any questions about the study:
Programme manager: Danielle Lamb
Call - 0207 679 9048
Email - d.lamb@ucl.ac.uk