Month: July 2018

New guidance to support decisions about introducing or spreading innovations in the NHS

Posted on by CLAHRC

What is the role of evidence in decisions about introducing or spreading innovations in health care?

Faced with a myriad range of innovations – in technology, medicine, ways of working and in organising services what do those who plan and commission services have to call on? 

We know that a range of evidence informs healthcare decision-making, from formal research findings to ‘soft intelligence’ or local data, as well as practical experience or tacit knowledge. However, cultural and organisational factors often prevent the translation of such evidence into practice.

New guidance from the“DEcisions in health Care to Introduce or Diffuse innovations using Evidence” (DECIDE) study has been published to support decision-makers and evaluators in the use of evidence in their work.

A team funded by the Health Foundation and led by researchers at the University of Manchester and University College London has investigated decision-makers’ use of diverse forms of evidence, exploring how and why some evidence does inform decisions to introduce health care innovations, and why barriers persist in other cases. The guidance was developed in consultation with clinicians, health managers, commissioners, patient representatives, and researchers.

The guidance is the end point of two years work involving a review of current evidence; examination of three case studies of real world decision-making on innovations in NHS acute and primary care; and a national survey and discrete choice experiment of decision-makers’ preferences for evidence, including providers and commissioners.

 

The accessible document – available as an interactive PDF, is aimed at anyone concerned with informing or making decisions about introducing or spreading innovations within the UK National Health Service, including providers and commissioners of care. It provides a summary the team’s findings, questions for decision-makers to consider, and potential ways of addressing them using examples from case studies. The document also sign-post users of this guidance to further resources where appropriate.

 

 

 

 

 

Read more from the DECIDE team below –

Turner S. (2018) ‘Accelerating innovation in new ways of delivering health and social care’, Manchester Policy Blog, published 28 March 2018.

Turner S, D’Lima D, Hudson E, Morris S, Sheringham J, Swart N, Fulop N. (2017) ‘Evidence use in decision-making on introducing innovations: a systematic scoping review with stakeholder feedback’, Implementation Science 12:145. View bite-size summary.

Turner S, Morris S, Sheringham J, Hudson E, fulop NJ. (2016) ‘Study protocol: DEcisions in health Care to Introduce or Diffuse innovations using Evidence (DECIDE)’, Implementation Science 11:48.

 

Investigating the preferred balance of care between specialist and generalist doctors

Posted on by CLAHRC

Current debates on the NHS workforce include discussions on the best balance between

  • specialists – with highly specialised skills who are brilliant at doing a small number of things extremely well
  • and generalists –  who can do a wider range of things in less depth
Image courtesy SRG Partnership

Rising multimorbidity, an ageing population, and the increasing specialisation of medical treatment are all seen as driving the need to increase the number of doctors with generalist skills. Generalists breadth of expertise enables them to manage both acute and chronic health problems and have been put forward as the way to provide better care for the increasing numbers of older and more complex patients requiring emergency medical admission.

A team of researchers from University College London and the Nuffield Trust is investigating the models of medical generalism currently in use in smaller acute hospitals in England and need your help.

A brief survey is asking for patient, professional and service perspectives on the balance of care between specialist and generalist models in hospitals for patients with acute medical conditions.

We would be very grateful if you could complete the survey within the next three weeks please, and we would like to encourage you to complete it at your earliest convenience. This will ensure we capture your views on models of care in small hospitals. The survey will take at most 5-10 minutes to complete. All responses will be handled securely, kept strictly confidential and anonymous, and stored in line with the Data Protection Act 1998 and new General Data Protection Regulation (GDPR).

Further details about the study are available here:

https://www.nuffieldtrust.org.uk/project/medical-generalism-in-smaller-hospitals

https://www.journalslibrary.nihr.ac.uk/programmes/hsdr/1419502/#/

Your views will provide vital evidence as part of this research, which will impact decision making around ways of working in hospitals relating to

  • issues around workforce education
  • continuing professional development and contractual arrangements
  • and the future of smaller hospitals and their role in the wider healthcare system.

Introduction to Economic Evaluation – 31st October 2018

Posted on by CLAHRC

Do you need to demonstrate the economic impact of projects in your organisations?

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 buy the NIHR CLAHRC North Thames Academy.  The course is aimed at staff in frontline services in the NHS and local governement, who have limited experience of conducting economic 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 economic evaluation, draft its core elements, identify the data you will need to use, think how you could overcome information or data gaps

This worksop is suitable for staff from NHS Trusts, Local Authorities and CCGs who need to evaluate local programmes or service 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 if 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.

Registration – Please complete the registration form and email to clahrc.academy@ucl.ac.uk by 5pm, Friday 31st August 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, Wednesday 24th October 2018.

For more information please contact clahrc.academy@ucl.ac.uk

 

Pulse checks in over 65s sees major improvements in the detection of atrial fibrillation

Posted on by CLAHRC

New CLAHRC research highlights a simple intervention that could improve detection of atrial fibrillation (AF) – a potentially dangerous heart condition affecting a million people in the UK and associated with 1 in 8 strokes (1 in 3 strokes among those aged over 80 years).

East London GP and CLAHRC researcher Dr John Robson led an investigation into the impact of regular pulse checks in general practice on AF detection among patients aged 65 and over. This work, published in the British Journal of General Practice, offers evidence that these checks – a cheap and straightforward intervention – rapidly improved the detection and prevalence of AF, meaning quicker access to treatment and reduced risk of stoke for those diagnosed.

The condition causes an irregular and often abnormally fast heart rate and is a leading cause of stroke – with strokes caused by underlying AF twice as likely to be fatal. AF is common in older people, but often shows no symptoms – meaning earlier detection and access to treatment means reduced risk of stroke and the health problems stroke victims have to live with afterwards.

Dr Robson and his team checked historical GP records to investigate the impact of a programme promoting pulse regularity checks across three groups of East London GP practices (or Clinical Commissioning Groups) –  City and Hackney, Newham, and Tower Hamlets.

An analysis of electronic primary care patient records before (2007–2012) and after (2012–2017) checks were introduced showed significant increases in AF detection.

Br J Gen Pract. 2018 Jun;68(671):e388-e393. doi: 10.3399/bjgp18X696605
Opportunistic pulse checks in primary care to improve recognition of atrial fibrillation: a retrospective analysis of electronic patient records.
Cole J, Torabi P, Dostal I, Homer K, Robson J