Integrating Home-Based Exercise Training with a Hospital at Home Service for Patients Hospitalised with Acute Exacerbations of COPD: Developing the Model Using Accelerated Experience-Based Co-Design

Figures & data

Figure 1 Schematic of the stages of this accelerated experience-based co-design project.

Table 1 Accelerated Experience-Based Co-Design Project Attendees at Each Stakeholder Feedback Event and Co-Design Group

Stakeholder Feedback Events
Healthcare professional event
Pulmonary rehabilitation team members n=5	Qualified physiotherapists (n=4; female: n=4) Physiotherapy assistant (n=1; female: n=1)
Hospital at home service members n=2	Specialist nurse (n=1; female: n=1) Specialist physiotherapist (n=1; male: n=1)
Service user event
Patients with COPD n=5	Previously underwent pulmonary rehabilitation and received hospital at home care (n=2; male: n=1; female: n=1) Previously underwent pulmonary rehabilitation only (n=3: male: n=1; female: n=2)
Relatives or carer of person with COPD n=2	Observed pulmonary rehabilitation (n=1; female: n=1) Observed hospital at home care (n=1; female: n=1)
Joint service user-healthcare professional event
Patients with COPD n=6	Previously underwent pulmonary rehabilitation and received hospital at home care (n=3; male: n=2; female: n=1) Previously underwent pulmonary rehabilitation only (n=3; male: n=1; female: n=2) Did not attend did not attend separate service user feedback event: 2/6
Pulmonary rehabilitation team members n=3	Qualified physiotherapists (n=2; female: n=2) Physiotherapy assistant (n=1; male: n=1) Did not attend separate healthcare professional feedback event: physiotherapy assistant
Hospital at home service members n=2	Consultant respiratory physician (n=1; female: n=1) Specialist physiotherapist (n=1; male: n=1) Did not attend separate healthcare professional feedback event: consultant respiratory physician
Co-design groups
Service user and healthcare professional co-design group
Patients with COPD n=2	Previously underwent pulmonary rehabilitation and received hospital at home care (n=2; female: n=2) Did not attend the stakeholder feedback events:2/2
Relative or carer of person with COPD n=1	Observed pulmonary rehabilitation and hospital at home care (n=1; female: n=1) Did not attend stakeholder feedback events: 1/1
Pulmonary rehabilitation team members n=1	Qualified physiotherapist (n=1; male: n=1) Did not attend stakeholder feedback events: 0/1
Hospital at home service members n=2	Specialist nurses (n=2: female: n=2) Did not attend the stakeholder feedback events: 2/2
Healthcare professional co-design group
Pulmonary rehabilitation team members n=5	Qualified physiotherapists (n=4: female: n=4) Physiotherapy assistant (n=1; male: n=1) Did not attend stakeholder feedback events:2/4 qualified physiotherapists

Abbreviations: COPD, chronic obstructive pulmonary disease; EBCD, experience-based co-design.

Table 2 Summary of the Findings: Four Key Themes and Their Related Sub-Themes

Theme	Sub-Themes
1. Individualisation of the home-based exercise training	–
2. Progression and transitions during home-based exercise training and outpatient-based programme	–
3. Continuity between services	Content delivered Timing of delivery Skill set of the healthcare professionals Types of assessments required
4. Communication between stakeholders	Communication between healthcare professionals Communication between healthcare professionals and service user

Figure 2 Schematic of the final co-designed model of care. *Research Physiotherapist to ask participant re: preference for outpatient PR location, and when referral to outpatient PR may be acceptable to participant; Research Physiotherapist to identify availability for the preferred class at proposed start date. +Deliver education topics alongside home-based exercise training using PR education pack/presentations and HIRS self-management plan; begin education with pacing, breathing control, positions of ease, anxiety management, self-management plan, smoking cessation, inhaler technique and airway clearance. ^Research Physiotherapist to refer participant into outpatient PR if/when the participate consents to the referral; the same referral and triaging process to be followed when refereeing participants into an outpatient PR programme as usual care; continue the home-based exercise training programme until the outpatient PR class begins. ~Research Physiotherapist to provide copy of home-based exercise training programme to outpatient PR; PR Physiotherapist to complete short pre-PR assessment; PR Physiotherapist to complete a short post-PR assessment at the end of the after 8 weeks of outpatient PR programme.

Abbreviations: COPD, chronic obstructive pulmonary disease; HaH, hospital at home; HIRS, Hillingdon Integrated Respiratory Service; PR, pulmonary rehabilitation.