New research published on the use of a Digital COVID-19 tracker in care homes across Greater Manchester

Researchers from the National Institute for Health and Care Research (NIHR) Applied Research Collaboration Greater Manchester (ARC-GM) and the University of Manchester, recently published two papers in BMC Infectious Diseases and Implementation Science Communications, on the implementation, uptake and use of a digital COVID-19 tracker in care homes across Greater Manchester.

The research team found a number of key factors influenced the uptake and use of the tracker by care home staff and clinicians:

• The way the COVID-19 tracker was implemented in each locality, in terms of piloting, training of care home staff and stakeholder engagement.
• Changes in the ways care homes worked during the pandemic and differences in the ways localities managed COVID-19 in care homes.
• The priority placed on using the tracker in the context of wider system pressures.

The COVID-19 symptom tracker rolled out across Greater Manchester by Health Innovation Manchester, was adapted from a pre-pandemic digital tool developed for falls prevention in care homes. Adaptations to the digital tool allowed care home staff to collect resident data on COVID-19 symptoms as well as other key indicators including confusion.

The tracker was designed for care home staff to assess residents’ health status and identify early signs of deterioration. It was intended that data would be made available to residents' designated care teams to facilitate care responses. The data collected through the tracker were combined with data on staffing levels, residency occupancy levels and personal protective equipment (PPE) availability to create a single integrated COVID-19 dashboard.

The recently published research found that:

• The use of the COVID-19 symptom tracker in care homes was not maintained, except in one locality.
• Tracker use decreased over time, and at different rates in different localities, with average use (proportion of residents assessed with the tool) ranging between 18% and 58%.
• Use of the tracker did not appear to reduce the spread of COVID-19.
• The number of COVID-19 cases in care homes was mainly driven by the prevalence of COVID-19 in the area around the care home and rates of infection among staff members.
• The local context differed between localities and the process of implementation changed from the initial strategy over time in terms of stakeholder engagement and training for care homes.

The tracker was introduced in Greater Manchester at the beginning of the pandemic as a potentially valuable response to COVID-19 for care homes. However, variation in its implementation and competing pressures such as the COVID-19 testing and vaccination programmes meant that its use decreased over time.

Dr Pauline Nelson (Research Fellow at The University of Manchester and NIHR ARC-GM)

“When the COVID-19 symptom tracker was introduced early in the pandemic at a time of great uncertainty and need in care homes, there was no alternative solution for tracking residents’ COVID symptoms. Over time the tracker was considered more useful for non-COVID aspects, such as storing information in one place and closer observation of residents’ general health. Indeed, care home managers expressed a willingness to work more digitally in the future with an adapted tracker for use beyond COVID.

 

Our NIHR ARC-GM work highlights key factors to guide future development and implementation of digital solutions in the care sector.”

This work supports prior research on the implementation of e-health innovations to highlight that the future development and implementation of rapid digital responses in care home settings – even in times of crisis – could be informed by three key factors:

1. an incremental approach to implementation with testing of organisational readiness and attention to the implementation climate;
2. involvement of end-users in innovation design and development; and
3. enabling users’ easy access to sustained, high-quality, appropriate training and support to enable staff to adapt to digital solutions.

More information about this mixed methods research, the full project report and the actionable findings are available from the Digital Care Homes webpage here.

The two published papers in BMC Infectious Diseases and Implementation Science Communications, are open access and freely available:

• Nelson, P.A., Bradley, F., Ullah, A., Whitaker, W., Brunton L., Calovski, V., Money A., Dowding D., Cullum N., & Wilson, P., Implementation, uptake and use of a digital COVID-19 symptom tracker in English care homes in the coronavirus pandemic: a mixed-methods, multi-locality case study. Implementation Science Communications (2023)
• Ullah, A., Whittaker, W., Bradley, F., Nelson P.A., Dowding, D., Morciano, M., & Cullum, N.,  The use and impact of digital COVID-19 tracking in adult social care: a prospective cohort study of care homes in Greater Manchester. BMC Infectious Diseases (2023)

Published 7/3/2023