Improving Quality in Adult Long Covid Services: Findings from the LOCOMOTION Quality Improvement Collaborative.
Darbyshire J., Greenhalgh T., Bakerly ND., Balasundaram K., Baley S., Ball M., Bullock E., Cooper R., Davies H., De Kock JH., Echevarria C., Elkin S., Evans R., Falope Z., Flynn C., Fraser E., Halpin S., Jones S., Lardner R., Lee C., Lovett A., Masey V., Master H., Mir G., Mosley A., Mullard J., O'Connor RJ., Parkin A., Pick A., Scott J., Smith N., Tucker E., Williams P., Winch D., Wood C., Sivan M., LOCOMOTION consortium None.
The protracted form of COVID-19 known as 'long covid' was first described in 2020. Its symptoms, course and prognosis vary widely; some patients have a multi-system, disabling and prolonged illness. In 2021, ring-fenced funding was provided to establish 90 long covid clinics in England; some clinics were also established in Scotland and Wales. The NIHR-funded LOCOMOTION project implemented a UK-wide quality improvement collaborative involving ten of these clinics, which ran from 2021 to 2023. At regular online meetings held approximately 8-weekly, participants prioritized topics, discussed research evidence and guidelines, and presented exemplar case histories and clinic audits. A patient advisory group also held a priority-setting exercise, participated in quality meetings and undertook a service evaluation audit. The goal of successive quality improvement cycles aimed at changing practice to align with evidence was sometimes hard to achieve because definitive evidence did not yet exist in this new condition; many patients had comorbidities; and clinics were practically constrained in various ways. Nevertheless, much progress was made and a series of 'best practice' guides was produced, covering general assessment and management; breathing difficulties; orthostatic tachycardia and other autonomic symptoms; fatigue and cognitive impairment; and vocational rehabilitation. This paper summarises key findings with the front-line clinician in mind.