Research Partnership on Caring for Cirrhosis Closer to Home (COACH)

BACKGROUND

Chronic liver disease is an ignored epidemic with significant premature mortality. The majority of deaths from liver disease result from cirrhosis or its complications. The therapeutic strategies that have been studied to slow disease progression in cirrhosis have been carried out in highly selected patient population in specialised liver centres.

Currently in the UK, most of the clinical care for patients with cirrhosis is concentrated in secondary care and this has exacerbated the disparity between the clinical need and provision of specialist liver services across the UK.

In line with the 2019 NHS Long Term Plan, delivering community-based interventions for patients with cirrhosis will boost out-of-hospital care and dissolve the historic divide between primary and secondary care. In the current climate of unprecedented pressure on both primary and secondary care, the optimal ways to integrate and deliver these community-based interventions are unknown.

AIMS & OBJECTIVES

We aim to establish and develop a partnership across diverse geographical areas (East Midlands, Yorkshire and London) with capacity and capability to deliver high quality research in the field of community care for patients with cirrhosis. Objectives are to: • Develop a sustainable, cross-sectoral collaborative research partnership.

• Understand the strengths, weaknesses, barriers and enablers of research readiness across the partnership. • Share topic and methodological expertise across the partnership • Identify key research questions, co-design and submit competitive research proposal to NIHR. PARTNERSHIP ACTIVITIES

Phase 1 – Working together (Months 1-2): We will establish the partnership infrastructure and identify key contacts within each region. We will hold networking events across the partnership to invite key stakeholders, co-produce ground rules for working together and create COACH website.

Phase 2 – Developing together (Months 3-12): We will understand and strengthen the research capacity and capability of the partnership by mapping current services, providing structured training and mentorship for clinicians and allied healthcare professionals. This phase will also involve training and capacity building for patient and public stakeholders, including those from historically underserved groups, who will be engaged throughout the project and inform the work.

Phase 3 – Building together (Months 9-18): we will explore and finalise research questions across the partnership. We will organise a research question generation exercise and the top priority research questions will be developed into proposals in workshops hosted by Nottingham Clinical Trials Unit. The workshops will focus on shaping the proposal, strengthening the methodology and provide space for constructive feedback from stakeholders including patient and public representatives.

TIMELINES FOR DELIVERY: 18 months ANTICIPATED IMPACT

The partnership will establish top-priority research questions and submit collaborative research proposals to the NIHR aiming to answer these questions. We will ensure that the diverse teams across the country are well prepared to deliver high-quality research in community care in cirrhosis. In addition, we will develop a critical mass of research-ready partners in primary and secondary care.

The learning from the partnership will be disseminated via public engagement events, conferences and academic papers.