Predictors and outcomes of ambulance calls to care homes for emergencies in people with diabetes (ACCHED) – retrospective observational database study

Funding body National Institute for Health Research Collaboration for Leadership in Applied Health Research and Care
Total funding  £23,851
  • Prof Niro Siriwardena, University of Lincoln
  • Professor Graham Law, University of Lincoln
  • Dr Murray Smith, University of Lincoln
  • Professor Mo Ray, University of Lincoln
  • Viet-Hai Phung, , University of Lincoln
  • External partners:
  • Anne Spaight, East Midlands Ambulance Service NHS Trust
  • Keith Spurr & Amanda Brewster – Patient and Public Involvement
  • Profeessor Kamlesh Khunti, University of Leicester
  • Dr Iskander Idris, University of Nottingham and Derby Teaching Hospital
  • University of Lincoln
  • East Midlands Ambulance Service NHS Trust
  • University of Leicester
  • University of Nottingham
  • Derby Teaching Hospital
Overarching aim This study is primarily an evaluation of diabetes emergency calls from care homes to an ambulance service. Our overall aim is to evaluate the demographic and clinical factors which predict ambulance conveyance to hospital together with health service costs of ambulance calls to patients with diabetes-related problems residing in care homes
Objectives Our objectives are:

  • To determine the extent to which socio-demographic attributes such as age, sex, deprivation and clinical factors such as reason for call, and other factors listed below (in ii below) are associated with ambulance calls for patients with diabetes-related emergencies resident in care homes.
  • To explore which factors predict whether patients are conveyed to hospital following an ambulance attendance for a diabetes-related emergency.
  • To conduct a health economic analysis.
Methods Cross sectional study
  • We will describe data in terms of rates of calls to patients in care homes for diabetes-related problems using funnel plots to identify outliers, as well as comparing these to rates for other types of calls.
  • We will use multivariate logistic and multilevel regression to explore predictors of conveyance to hospital when an ambulance is called to a patient with diabetes-related problems considering factors such as patient age, sex, distance to hospital, rurality, deprivation and other clinical and demographic described above.
  • Episodes will be costed using the National Schedule of Reference Costs for NHS Trusts and NHS Foundation Trusts for different types of call, e.g. call only (‘hear and treat’) attendance only (‘see and treat’) and attendance followed by transport to hospital (‘see, treat and convey’). Statistical and economic analyses will be conducted using SPSS, Stata and R.
Outputs Peer reviewed publications and conference presentations.
Impact The findings will:

  • Inform development of educational interventions and pathways for ambulance and care home staff to reduce preventable call-outs and hospital admissions for diabetes emergencies through better integration of patient care in care homes and health services.
  • Increase knowledge of organisational, patient and clinical factors leading to hospital admission following diabetes emergencies in care home residents.
  • Publish new evidence based data on the scale, nature and costs of diabetes emergencies in care homes.
  • Reduce risk of hypoglycaemia, hyperglycaemia and dehydration in people with diabetes in care homes.


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