PP40 Co-design and refinement of a logic model describing case management for people who frequently call ambulance services – the stretched evaluation

<h3>Background</h3> Multi-agency case management across the UK addresses the needs of those who call 999 ambulance services frequently (≥5 times in a month, or ≥12 times in a three-month period). However, there is little evidence about what works and how. STRETCHED (Strategies to Manage Emergency Ambulance Telephone Callers with Sustained High needs – an Evaluation using Linked Data) evaluated case management using mixed methods. One objective was to develop and refine a logic model to describe cross-sectoral case management and its expected impacts, as a basis for evaluation. <h3>Methods</h3> Stage 1: We conducted a stakeholder event with 37 people from Wales, England and Northern Ireland including public partners (with lived experience) and relevant staff to develop an initial logic model. Stage 2: Following the main data collection and analysis phases of the study, we reviewed and refined the logic model in the light of findings. <h3>Results</h3> The logic model summarises in graphic form: <b>Inputs:</b> resources and activities <b>Mechanisms of change:</b> at organisational and individual level <b>Impacts:</b> on service users, ambulance services, individual staff, and wider service networks. Study findings showed that: case management initiatives varied considerably between sites; patients had a high level of need with high mortality and rates of hospital admission; the conditions of many patients are not amenable to individual behaviour change. We then revised the logic model to show: the range of contextual/mediating factors shaping local initiatives variation in case management activities between sites a reduced emphasis on individual behaviour change. <h3>Conclusion</h3> In this challenging and complex area of health care, a logic model can be an essential tool to support evaluation, and refined on the basis of study insights.