CLAHRC researchers highlight potential to use patient-reported outcomes for emergency admissions.
Patient-reported outcome measures or PROMs are a well-established method of capturing the views of NHS patients, allowing the service to assess the quality of care delivered, from the patient perspective.
PROMs use pre- and post-operative surveys completed by patients to calculate their health gains after surgical treatment.
While there is an extensive PROM programme across the English NHS, they have yet to be used in emergency admissions. These account for nearly 40% of all hospital admissions and are an area of increasing demand. However, this is also an area where the NHS knows least about;
the quality of patient outcomes,
whether resources are being used effectively,
and whether there are unexpected variation between different providers
CLAHRC researcher and PhD Dr Esther Kwong investigated how to use PROMs to evaluate the quality of acute and emergency hospital care in the NHS. Esther developed and tested PROMS with patients who underwent emergency admissions, establishing that it is feasible to use PROMS in this clinical area.
They are presented in four new CLAHRC BITEs – postcard summaries of Esther’s published academic papers.
Do you need to demonstrate the impact of projects in your organisation?
Do you want to improve the design and implementation of your programme?
Are you tasked with carrying out an evaluation, but don’t know where to start?
This one day, hands-on workshop, run by the NIHR CLAHRC NorthThames Academy, addresses these challenges. It is aimed at staff from NHS Trusts, CCGs and Local Authorities, who have limited experience of conducting service evaluations.
After attending this workshop, you will have the skills and knowledge to undertake your own evaluation of a local programme or service.
The course covers:
Different types of evaluation, including their pros and cons
How to select suitable methods and approaches for evaluating a local programme or service
Practical skills and tips in using evaluation methods and approaches
Ways of sharing your evaluation findings to make an impact
This workshop is suitable for staff from NHS Trusts, Local Authorities and CCGs. It is not aimed at academics and/or researchers. Participants should attend the course with an evaluation in mind that they may need to carry out. No previous experience of study design, statistics or evaluation is needed.
All participants will receive a certificate of attendance.
Cost – This course is free for staff working in NIHR CLAHRC North Thames partner organisations (please click here to see a list of our partners). There is adelegate fee of £250 for other attendees.
Women who experience domestic violence and abuse (DVA) are more than twice as likely to seek emergency contraception as other women, according to a study by National Institute for Health Research (NIHR)-funded researchers at the University of Bristol and Queen Mary University of London, suggesting that requests for emergency contraception could be an important sign of abuse.
In the study, published in the British Journal of General Practice today, the researchers analysed medical records of over 200,000 women of reproductive age registered with a GP and found that those who had a record of DVA were 2.06 times more likely to have a consultation for emergency contraception compared to other women, rising to 2.8 times for women aged 25-39.
The researchers also found some evidence that abused women are more likely to seek emergency contraception repeatedly.
DVA is a major public health problem, with devastating consequences for the women who experience it and great financial cost to the NHS. It is known to have a significant impact on women’s reproductive health, including an increased risk of unintended pregnancy and abortion, as abusive and controlling partners coerce women to have unprotected sex or rape them.
Although emergency hormonal contraceptive, also known as the morning-after pill, is available from pharmacies, women can also get it from their GP. Up to a third of all emergency contraceptives are prescribed by GPs.
The researchers are calling for this new evidence to be included in existing DVA training programmes for GPs and sexual health practitioners, and for the training to be extended to community pharmacists, to help them identify and refer women who have experienced DVA on to specialist support services. Such programmes are recommended by the National Institute for Health and Care Excellence (NICE) and the World Health Organization (WHO) as part of a multi-sector response to DVA.
Joni Jackson, Research Associate from the NIHR Collaboration for Leadership in Applied Health Research (CLAHRC) West and co-lead author of the study, said:
“We found a strong positive association between exposure to domestic violence and abuse and requests for emergency contraception. Our findings are in line with evidence from studies in other countries suggesting that women experiencing DVA use more emergency contraception than other women. GPs, pharmacists and sexual health practitioners are at the frontline responding to these requests, with community pharmacists dispensing 50% of all emergency contraceptive pills. This presents an important opportunity to identify women experiencing DVA, signpost them to appropriate support services, and potentially save lives.”
Dr Natalia Lewis, from the Centre for Academic Primary Care at the University of Bristol and co-lead author, said:
“The negative impact of domestic violence and abuse on health results in higher use of healthcare services by abused women compared to the general population. This means that healthcare services are an important point of contact for DVA victims and survivors. We have already seen improvements in GPs’ ability to identify and refer women experiencing DVA through the success of the IRIS (Identification and Referral to Improve Safety) programme. IRIS has recently been adapted for sexual and reproductive health services. Our findings support the case for adapting the IRIS intervention to the community pharmacy setting, although more research is needed to explore if and how this could be done.”
The research was supported by NIHR CLAHRC West and CLAHRC North Thames.
Dr Werner Leber, an East London GP with a passion for driving earlier identification and diagnosis of HIV, has seen his work recognised by the European agency responsible for the continent’s defences against infectious disease – the European Centre for Disease Prevention and Control (ECDC).
Werner’s research among East London’s GP practices will now have a Europe-wide impact after being highlighted as good practice by the ECDC in its first integrated European hepatitis B virus (HBV) hepatitis C virus (HCV) and HIV testing guidance. The trial is summarised on page 71 of the guidance.
“The results support the hypothesis that an education programme promoting rapid HIV testing in general practice leads to increased and earlier HIV diagnosis.”
Public health guidance on HIV, hepatitis B and C testing in the EU/EEA; An integrated approach European Centre for Disease Prevention and Control, 2018
In this trial in Hackney, general practices were randomly assigned to offer either opt-out rapid HIV testing to newly registering adults or continuing usual care. The study found that promotion of opt-out rapid testing in general practice led to an increased rate of diagnosis, and might increase early detection, of HIV.
In developing the guidance the ECDC looked for excellent examples of HBV, HCV and HIV testing services across EU/EEA Member States, reviewing the latest evidence and putting out two published calls for submissions of good practice.
Healthcare systems around the world are becoming more concerned with strengthening board level governance of quality. In England, national healthcare regulators are developing approaches, resources and interventions aimed at supporting senior hospital leaders in their role in the governance of quality.
New CLAHRC research investigates the organisational response to an improvement intervention in six hospital boards across England. The research, published in a new BMJ paper and BITE-sized summary shows the results a 30-month period of fieldwork, involving interviewing NHS board members, observing board meetings and analysing relevant documentation.
The findings will be relevant to NHS Boards, the staff and clinicians they lead and all those in the NHS working to improve the quality and safety of care.
As well as researchers, the results will be of interest to policymakers, regulators, knowledge mobilisation organisations and thinkers on boards and leadership across all sectors.
Background Healthcare systems worldwide are concerned with strengthening board-level governance of quality. We applied Lozeau, Langley and Denis’ typology (transformation, customisation, loose coupling and corruption) to describe and explain the organisational response to an improvement intervention in six hospital boards in England.
Read a BMJ editorial highlighting the paper as “an example of an empirical study that successfully enters into dialogue with management theory”
Repeated calls have been made for the increased use of theory in designing and evaluating improvement and implementation interventions.1-4 The benefits are argued to include identifying contextual influences on quality improvement (QI), supporting the generalisability of findings and anticipating how future phenomena might unfold.2 5 Most importantly, the ability of
Within the UK, 32 out of every 10,000 children are living with a life-limiting condition or life-threatening illness (LLC/ LTI).
Research, from genetic studies to drug trials is vital to improving care for these children and their families, but the inclusion of this vulnerable population into research studies has been difficult.
A new BITE – a postcard “need to know” summary of our published research – shares the perceptions of clinicians and research leaders on their perceptions of the barriers preventing children and their families becoming involved in research.
The BRAVES team surveyed palliative care clinicians, often “gatekeepers” to children and their families getting involved in research asking them
‘In your experience, what have you found to be the biggest barriers to palliative care research with children?’
We also consulted Chief Investigators (CIs) – leaders of NIHR research studies involving CYP with LLC/LTI and their families. CI’s were invited to complete an anonymous, web-based questionnaire and three key barriers to research were emerged, alongside four potential solutions.
Local research bodies join forces with patient partners to deliver an introduction to research
We ran our Becoming Research Active course on November 14th offering our partners in front-line care a primer in research and the research process.
CLAHRC North Thames Academy collaborated with other NIHR funded research organisations in the region – the Clinical Research Network and Research Design Service – to deliver the training, with vital contributions from patients and members of the public.
The day-long course is structured to reflect the research cycle – from defining a problem, through securing funding to dissemination and evaluation. Attendees, who came from across the NHS and local authorities were encouraged to bring a research idea they could develop over the course of the day.
“The course has provided me with lots of resources and a clearer sense of direction, which is what I hoped for.”
We joined forces with NIHR infrastructure across the North Thames region – the Research Design Service which provides support to those preparing research proposals for submission to peer-reviewed funding competitions for applied health or social care research; and the local Clinical Research Network which makes it possible for patients and health professionals across England to participate in clinical research studies.
The training aimed to highlight the processes involved in planning and carrying out successful research, in partnership with patients and the public, and signpost attendees to the support available to them.
We were also very fortunate to have some patients and members of the public bringing their unique lived experience – of working with researchers, leading research and being a clinical trial participant respectively to offer tips to attendees.
CLAHRC Research Advisory Panel member Ayath Ullah (below left) joined the CLAHRC’s involvement officer Steven Towndrow to offer a lay perspective on how researchers can make patient/public advisers welcome and valued.
One of the CRN’s Patient Research Ambassadors (PRAs) Phillip Wingfield spoke about his experience of taking part in two clinical trials, offering a perspective from a participants point of view.
We were also joined by community researchers Sultana and Farzana from the NEON project, where they have led research into improving nutrition practices among the Bangladeshi community in East London.
“Useful to have a range of speakers with varied experience. Great place to come prior to starting research.”
Researchers, staff and health professionals delivered a range of presentations with small group work and regular exercises to reinforce learning, and were on hand to facilitate each part of the day.
Feedback from attendees was overwhelmingly positive;
“Very useful and informative.”
“Lots of information to move forward my idea. Thank you very much.”
“A good overview of processes. Helpful to know all the help/support available.”
“Very well designed and delivered. It kept my attention throughout. The content/sessions were well balanced and provided me with the basis to build on”
We are offering follow up sessions with attendees to support the development of research ideas into action, and we plan to run the course again in summer 2019. Get in touch to join our mailing list to find out when courses are planned – email@example.com.
Young Commissioners residential training for Dudley Council Integrated Commissioning hub, 2-4 November 2019
The “Young Commissioner” model – which sees children and young people work with funders and planners of local services to ensure they meet the needs of those in their age group – is gaining traction among local authorities and the NHS.
CLAHRC North Thames child and adolescent researchers are training and supporting staff and young people based at Dudley Council, West Midlands to establish and embed the Young Commissioner model in their Integrated Commissioning Hub. This follows our work with a previous cohort of young people in East London to improve diabetes services.
Over the weekend of 2-4 November this residential event kicked-off the training programme for the young people using the principles of ‘learning by doing’. This has involved blending training with real-time commissioning activities.
The Young Commissioners worked with graphic facilitator Penny Mendonca on public speaking and presentation skills, and the different communication channels they could use.
Adult learners have also accessed project-specific eCPDs developed by the team to help them better align Council systems, structures and processes to optimise the impact and sustainability of this initiative. The adoption of the Young Commissioners model marks an area of innovation in how they work together with the public to commission children and young people’s services.
Do you need to demonstrate the economic impact of projects in your organisation?
Do you want to assess the outcomes and sustainability of a new service?
Are you tasked with carrying out an economic evaluation, but don’t know where to start?
This one day, hands-on workshop aims to provide an introduction to addressing these challenges. It is run by the NIHR CLAHRC North Thames Academy. The course is aimed at staff in frontline services in the NHS and local government, who have limited experience of conducting evaluations and decision making analysis.
After attending this course, you will have the skills and knowledge to undertake your own simple economic evaluation of a local intervention or service, and be able to appraise other evaluations.
The course will cover:
introduce the basic principles of economic evaluation methods
explain how to assess the costs of an intervention/service
explain how to measure and value outcomes of an intervention/service
give practical examples of economic evaluation analysis
help to understand how to use economic evaluation in decision making
offer the opportunity to discuss in small groups the economic evaluation you are doing or thinking of doing. A facilitator will help scope your economci evaluation, draft its core elements, identify the data you will need to use, think how you could overcome information or data gaps.
This workshop is suitable for staff from NHS Trusts, Local Authorities and CCGs who need to evaluate local programmes or services from an economic perspective as part of their work. It is not aimed at academics and/or researchers.
In order to be most beneficial for the participants, we invite applications from individuals who are carrying out or soon will need to carry out an economic evaluation of a service/intervention. In the selection process, we will give priority to applications providing a detailed description of such projects. Groups of people working on the same project are encouraged to apply.
No previous knowledge of economics is required (or experience of study design and statistics), however an interest in economics and being comfortable with numbers is desirable.
All participants will receive a certificate of attendance.
Cost – This course is free for staff working in NIHR CLAHRC North Thames partner organisations (please click here to see a list of our partners). There is a delegate fee of £250 for other attendees.
A new publication highlights our work in evaluating a new patient pathway with the potential to provide clinicians with real-time data on inpatients at risk of Acute Kidney Injury.
AKI is common (affecting up to 20% of UK acute hospital admissions); associated with significant morbidity and mortality, and expensive – excess costs to the NHS in England alone may exceed £1 billion per year.
Researchers at the Royal Free Hospital (RFH), part of London’s Royal Free London NHS Foundation Trust (RFLFT) have developed a digitally-enabled care pathway for inpatients, incorporating a mobile software application – the “Streams-AKI” app – that “reads” routinely collected serum creatinine data in hospital inpatients and alerts health professionals where a patient is at risk of AKI.
We have published our protocol for this evaluation, and a postcard-style “need to know” summary – or BITE – of our research plans. We’ll measure its success for patients (in terms of speed and effectiveness of their diagnosis and care), NHS staff and clinicians (to find out what they think of the pathway) and for the NHS in terms of patients’ length of stay and costs to the service.
The protocol and BITE will interest NHS staff and clinicians working in renal care, as well as those interested in the potential of technology to improve detection and diagnosis via routinely collected data
NIHR CLAHRC North Thames conducts ground-breaking research that directly impacts the health of patients with long term conditions and the health of the public.