Evaluating a digitally-enabled care pathway for Acute Kidney Injury

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

Co-production in practice with young people in delivering a ‘perfect’ care pathway for diabetes

We’ve been working with young people to transform how local health diabetes services are designed and delivered for their age group.

CLAHRC researchers based at the University of East London worked with local young people to understand the options and barriers they face when given a diagnosis of diabetes and using NHS services.

We recruited a mixed young research team – in terms of age, ethnicity, faith-identities and backgrounds – who worked together over one year to help commissioners and providers better understand and address the options and barriers of delivering a ‘perfect’ care pathway.

You can see the results of this work in our latest BITE – a postcard summary of a CLAHRC research paper.

This is part of our wider work to co-design community-based diabetic services responsive to the needs of children and young people

How can we improve dementia care in UK black elders?

Black elders dismiss the warning signs of dementia until the condition becomes too severe to ignore or a crisis strikes. They are also less likely to receive a diagnosis of their condition, resulting in delayed treatment and
less time to plan for the future.

Our latest BITE – a summary of published CLAHRC research provides an overview of our work with black elders, their families and carers to;

  1. identify barriers and facilitators to seeking help for dementia.
  2. based on what we found, work with dementia patients and their          carers, volunteers from the public, clinicians and experts in the treatment and research of dementia to develop an intervention – a leaflet entitled Getting help for forgetfulness (below)
  3. trial the intervention with GP registered patients, who were asked to rate it and evaluate its effect on their intention to seek help from their doctor.

Medication adherence in asthma: can pharmacists help?

Preventer inhalers (inhaled corticosteroids) are a common medication for asthma, and people get the full benefit of the medication by taking their prescribed doses correctly. We know many patients struggle to take enough doses effectvely, which impacts their ability to manage the condition.

Could pharmacists hold the key to helping patients take medicines effectively and in the right doses?

Our latest BITE – a postcard “need to know” summary of our research – presents the findings of our review of the evidence on whether pharmacists involved in asthma care could help people take their preventer inhaler as prescribed, therefore giving them the full benefit of their medication.

CLAHRC evidence influences decisions on front-line services

New knowledge generated by our research impacts commissioning and funding decisions on welfare advice

Our work to investigate the impact of locating welfare advisers in GP surgeries is bearing fruit as the new knowledge and evidence we have generated is influencing commissioning decisions for these services across London and beyond.

We know that a significant amount of General Practitioners workload is generated by patients approaching them with non-clinical issues such as debt, housing and immigration.


While these concerns undoubtedly impact health and wellbeing, doctors are not necessarily the best professionals to assist. Haringey Council trialled a scheme to locate welfare advice, and welfare advisers in GP surgeries to deal with these issues. 

We evaluated the impact of this advice (provided by Citizen’s Advice Bureau staff) on both GP workloads and on the health, wellbeing and use of services by the patients affected.

Our evidence has been used to support the following decisions –

Haringey: our evidence was used to support retention of all except one primary care co-located welfare advice service in and to provide an additional more intensive service at a mental health hospital (St Ann’s Hospital);

Camden: although the CCG decided to cease funding for GP outreach two GP practices have used the study findings to support ongoing funding for services at their practices (including an application for Big Lottery funding)

Deryshire; Citizens Advice services in Derbyshire have requested study findings to support a business case for ongoing funding of GP outreach in the region

Sussex: our study has been used as a basis to develop an evaluation framework in Sussex


Read our evidence 



Read more about the study: 

Does locating welfare advice in GP surgeries improve health and reduce strain on the NHS?

Mayor launches school programme developed to improve self-management of asthma in young people

The Mayor of London, Sadiq Khan has launched a programme to improve the self-management of asthma by school children in the Capital. My Asthma in School was developed by CLAHRC researchers based at the Blizard Institute within Queen Mary University of London.

My Asthma in School

The programme uses educational workshops and theatre performance to improve asthma control and peer support for asthma in London secondary school.

Asthma affects approximately one in 11 children and young people in the UK; and young people with asthma have higher rates of school absences and visits to their doctor or the hospital. According to the data collected for the study, nearly half of young people (aged 11-18 years) with asthma did not have control over their condition.

Dr Gioia Mosler, Outreach and Learning Manager for the ‘My asthma in school project’, said: 

“The number of deaths from asthma in the UK rank among the highest in the EU. Many of these deaths could be prevented with better self-management.”

She added: “Improving the ability and motivation to self-manage asthma gives many young asthma sufferers the opportunity to improve their asthma control. As a result they would suffer less from common symptoms like coughing at night or breathlessness.”

My asthma in School is one of the first school-based interventions for asthma self-management in the UK. Similar trials have been undertaken outside the UK, however, given that the health and education systems differ, results from these interventions may not be transferable to a UK setting.

The programme has been approved and supported by Sadiq Khan, Mayor of London. Mayor Khan was himself diagnosed with the conditon as an adult –  which he attributes to London’s poor air quality and pollution levels.

He said: “The Greater London Authority and I believe that the ‘My Asthma in School’ programme is likely to promote the necessary education young people require to effectively self-manage their asthma.”

He added: “I encourage all London secondary schools to take part in this programme.”

Using behavioural change theories as a framework, researchers have developed a variety of engaging and entertaining media, such as apps, videos, and interactive games.

The intervention includes an interactive theatre performance (below), lasting approximately two hours, to help raise awareness of asthma among peers. The performance has been developed with partners at Greenwich and Lewisham Young People’s Theatre.

Dr Mosler added: “The theatre intervention addresses asthma from a new angle, focusing on peer awareness and support around young people with asthma. The questionnaire data we collected during phase one showed many barriers related to a perceived stigma around asthma. The theatre intervention addresses stigma around asthma in the peer group.”

The intervention will be trialled in London during the next few months. Given a positive result of this intervention it could be adopted as a wider programme to improve asthma in young people.

The programme is run as part of the My Health in School initiative which aims to improve life and health of young people at school. The team works with Professor Jonathan Grigg, who leads several studies about asthma and lung health in children and young people.

Introduction to Evaluation

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 North Thames 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 pro 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 or organisations (please click here to see a list of our partners).  There is a delegate fee of £250 for other attendees.

Registration – Please complete the registration form and email to clahrc.academy@ucl.ac.uk by 5pm, Friday 5th October 2018.

Please note, a cancellation fee of £100 will be charged to both partner and non-partner delegates in the event of non-attendance without notice after 5pm, Tuesday 4th December 2018.