Publications
397 results found
Bottle A, Gaudoin R, Goudie R, et al., 2014, Can valid and practical risk-prediction or casemix adjustment models, including adjustment for comorbidity, be generated from English hospital administrative data (Hospital Episode Statistics)? A national observational study
<h4>Background</h4>NHS hospitals collect a wealth of administrative data covering accident and emergency (A&E) department attendances, inpatient and day case activity, and outpatient appointments. Such data are increasingly being used to compare units and services, but adjusting for risk is difficult.<h4>Objectives</h4>To derive robust risk-adjustment models for various patient groups, including those admitted for heart failure (HF), acute myocardial infarction, colorectal and orthopaedic surgery, and outcomes adjusting for available patient factors such as comorbidity, using England’s Hospital Episode Statistics (HES) data. To assess if more sophisticated statistical methods based on machine learning such as artificial neural networks (ANNs) outperform traditional logistic regression (LR) for risk prediction. To update and assess for the NHS the Charlson index for comorbidity. To assess the usefulness of outpatient data for these models.<h4>Main outcome measures</h4>Mortality, readmission, return to theatre, outpatient non-attendance. For HF patients we considered various readmission measures such as diagnosis-specific and total within a year.<h4>Methods</h4>We systematically reviewed studies comparing two or more comorbidity indices. Logistic regression, ANNs, support vector machines and random forests were compared for mortality and readmission. Models were assessed using discrimination and calibration statistics. Competing risks proportional hazards regression and various count models were used for future admissions and bed-days.<h4>Results</h4>Our systematic review and empirical analysis suggested that for general purposes comorbidity is currently best described by the set of 30 Elixhauser comorbidities plus dementia. Model discrimination was often high for mortality and poor, or at best moderate, for other outcomes, for example c = 0.62 for readmission and c = 0.7
Tsang C, Bottle A, Majeed A, et al., 2013, NEW CANCERS ON EMERGENCY ADMISSION Care is needed in epidemiological research not to overgeneralise about cancer diagnosis and treatment, BMJ-BRITISH MEDICAL JOURNAL, Vol: 347, ISSN: 1756-1833
Nouraei SAR, Middleton SE, Hudovsky A, et al., 2013, A national analysis of the outcome of major head and neck cancer surgery: implications for surgeon-level data publication, CLINICAL OTOLARYNGOLOGY, Vol: 38, Pages: 502-511, ISSN: 1749-4478
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- Citations: 34
Bottle A, Middleton S, Kalkman CJ, et al., 2013, Global Comparators Project: International Comparison of Hospital Outcomes Using Administrative Data, HEALTH SERVICES RESEARCH, Vol: 48, Pages: 2081-2100, ISSN: 0017-9124
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- Citations: 49
Alexandrescu R, Bottle A, Jarman B, et al., 2013, Current ICD10 codes are insufficient to clearly distinguish acute myocardial infarction type: a descriptive study, BMC HEALTH SERVICES RESEARCH, Vol: 13, ISSN: 1472-6963
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- Citations: 16
Burns EM, Bottle A, Almoudaris AM, et al., 2013, Hierarchical multilevel analysis of increased caseload volume and postoperative outcome after elective colorectal surgery, BRITISH JOURNAL OF SURGERY, Vol: 100, Pages: 1531-U1538, ISSN: 0007-1323
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- Citations: 28
Bottle A, Sanders RD, Mozid A, et al., 2013, Provider profiling models for acute coronary syndrome mortality using administrative data, INTERNATIONAL JOURNAL OF CARDIOLOGY, Vol: 168, Pages: 338-343, ISSN: 0167-5273
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- Citations: 8
Bottle A, Mozid A, Grocott HP, et al., 2013, Preoperative risk factors in 10 418 patients with prior myocardial infarction and 5241 patients with prior unstable angina undergoing elective coronary artery bypass graft surgery, BRITISH JOURNAL OF ANAESTHESIA, Vol: 111, Pages: 417-423, ISSN: 0007-0912
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- Citations: 10
Symons NRA, Faiz OD, Moorthy K, et al., 2013, The effects of resource availability on mortality for emergency general surgical admissions, 99th Annual Clinical Congress of the American-College-of-Surgeons / 68th Annual Sessions of the Owen H Wangensteen Surgical Forum on Fundamental Surgical Problems, Publisher: ELSEVIER SCIENCE INC, Pages: S109-S109, ISSN: 1072-7515
Symons NRA, Moorthy K, Almoudaris AM, et al., 2013, Mortality in high-risk emergency general surgical admissions, BRITISH JOURNAL OF SURGERY, Vol: 100, Pages: 1318-1325, ISSN: 0007-1323
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- Citations: 142
Ruiz M, Bottle A, Aylin P, 2013, A retrospective study of the impact of the doctors' strike in England on 21 June 2012, JOURNAL OF THE ROYAL SOCIETY OF MEDICINE, Vol: 106, Pages: 362-369, ISSN: 0141-0768
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- Citations: 18
Mamidanna R, Almoudaris AM, Bottle A, et al., 2013, National outcomes and uptake of laparoscopic gastrectomy for cancer in England, SURGICAL ENDOSCOPY AND OTHER INTERVENTIONAL TECHNIQUES, Vol: 27, Pages: 3348-3358, ISSN: 0930-2794
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- Citations: 16
Palmer WL, Bottle A, Davie C, et al., 2013, Meeting the ambition of measuring the quality of hospitals stroke care using routinely collected administrative data: a feasibility study, INTERNATIONAL JOURNAL FOR QUALITY IN HEALTH CARE, Vol: 25, Pages: 429-436, ISSN: 1353-4505
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- Citations: 15
Tsang C, Bottle A, Majeed A, et al., 2013, Cancer diagnosed by emergency admission in England: an observational study using the general practice research database, BMC Health Services Research, Vol: 13, Pages: 1-9, ISSN: 1472-6963
BackgroundPatients diagnosed with cancer by the emergency route often have more advanced diseases and poorer outcomes. Rates of cancer diagnosed through unplanned admissions vary within and between countries, suggesting potential inconsistencies in the quality of care. To reduce diagnoses by this route and improve patient outcomes, high risk patient groups must be identified. This cross-sectional observational study determined the incidence of first-ever diagnoses of cancer by emergency (unplanned) admission and identified patient-level risk factors for these diagnoses in England.MethodsData for 74,763 randomly selected patients at 457 general practices between 1999 and 2008 were obtained from the General Practice Research Database (GPRD), including integrated Hospital Episode Statistics (HES) data and Office for National Statistics (ONS) mortality data. The proportion of first-ever diagnoses by emergency admission out of all recorded first cancer diagnoses by any route was analysed by patient characteristics.ResultsDiagnosis by emergency admission was recorded in 13.9% of patients diagnosed with cancer for the first time (n = 817/5870). The incidence of first cases by the emergency route was 2.51 patients per 10,000 person years. In adjusted regression analyses, patients of older age (p < 0.0001), living in the most deprived areas (RR 1.93, 95% CI 1.51 to 2.47; p < 0.0001) or who had a total Charlson score of 1 compared to 0 (RR 1.34, 95% CI 1.06 to 1.69; p = 0.014) were most at risk of diagnosis by emergency admission. Patients with more prior (all-cause) emergency admissions were less at risk of subsequent diagnosis by the emergency route (RR 0.31 per prior emergency admission, 95% CI 0.20 to 0.46; p < 0.0001).ConclusionsA much lower incidence of first-ever cancer diagnoses by emergency admission was found compared with previous studies. Identified high risk groups may benefit from int
King C, Aylin P, Chukwuemeka A, et al., 2013, Assessing data sources for sustainable and continuous surveillance: surgical site infections following coronary artery bypass grafts in England, JOURNAL OF HOSPITAL INFECTION, Vol: 84, Pages: 305-310, ISSN: 0195-6701
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- Citations: 3
Tsang C, Bottle A, Majeed A, et al., 2013, Adverse events recorded in English primary care: observational study using the General Practice Research Database, BRITISH JOURNAL OF GENERAL PRACTICE, Vol: 63, Pages: E534-E542, ISSN: 0960-1643
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- Citations: 27
Pinder RJ, Greaves FE, Aylin PP, et al., 2013, Staff perceptions of quality of care: an observational study of the NHS Staff Survey in hospitals in England, BMJ QUALITY & SAFETY, Vol: 22, Pages: 563-570, ISSN: 2044-5415
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- Citations: 16
Murray J, Saxena S, Modi N, et al., 2013, Quality of routine hospital birth records and the feasibility of their use for creating birth cohorts, JOURNAL OF PUBLIC HEALTH, Vol: 35, Pages: 298-307, ISSN: 1741-3842
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- Citations: 24
Aylin P, Alexandrescu R, Jen MH, et al., 2013, Day of week of procedure and 30 day mortality for elective surgery: retrospective analysis of hospital episode statistics, BMJ-BRITISH MEDICAL JOURNAL, Vol: 346, ISSN: 1756-1833
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- Citations: 195
Bottle A, Mozid A, Grocott HP, et al., 2013, Preoperative Stroke and Outcomes after Coronary Artery Bypass Graft Surgery, ANESTHESIOLOGY, Vol: 118, Pages: 885-893, ISSN: 0003-3022
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- Citations: 23
Almoudaris AM, Mamidanna R, Bottle A, et al., 2013, Failure to Rescue Patients After Reintervention in Gastroesophageal Cancer Surgery in England, JAMA SURGERY, Vol: 148, Pages: 272-276, ISSN: 2168-6254
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- Citations: 37
King C, Alvarez LG, Holmes A, et al., 2013, Questions linked to King C, Alvarez LG, Holmes A, Moore L, Galletly T, Aylin P. Risk factors for healthcare-associated urinary tract infection and their applications in surveillance using hospital administrative data: a systematic review. <i>J Hosp Infect</i> 2012;82:219-226, JOURNAL OF HOSPITAL INFECTION, Vol: 83, Pages: 167-167, ISSN: 0195-6701
Palmer WL, Bottle A, Davie C, et al., 2013, Weekend Admissions and Increased Risk for Mortality: Less Urgent Treatments Only? reply, JAMA NEUROLOGY, Vol: 70, Pages: 132-133, ISSN: 2168-6149
Palmer WL, Bottle A, Davie C, et al., 2013, Weekend Admissions and Increased Risk for Mortality: Less Urgent Treatments Only? <i>Reply</i>, JAMA NEUROLOGY, Vol: 70, Pages: 132-133, ISSN: 2168-6149
Burns EM, Currie A, Bottle A, et al., 2013, Minimal-access colorectal surgery is associated with fewer adhesion-related admissions than open surgery, Br J Surg, Vol: 100, Pages: 152-159, ISSN: 1365-2168
BACKGROUND: This study aimed to describe national intermediate-term admission rates for incisional hernia or clinically apparent adhesions following colorectal surgery, and to compare rates following laparoscopic and open approaches. METHODS: Patients undergoing primary colorectal resection between 2002 and 2008 were included from the Hospital Episode Statistics database. Subsequent inpatient admissions were extracted for up to 3 years after the initial operation or to the end of the study period. Outcomes examined were admissions with a diagnosis of, or operative interventions for, incisional hernia or adhesions. RESULTS: A total of 187 148 patients were included between 2002 and 2008, with median follow-up of 31.8 (interquartile range 13.1-35.3) months. Some 8885 (4.7 per cent) of these patients were admitted with a diagnosis of, or underwent a repair of, an incisional hernia. In multiple regression analysis, use of laparoscopy was not a predictor of operative intervention for incisional hernia (odds ratio 1.09, 95 per cent confidence interval (c.i.) 0.99 to 1.21; P = 0.083). Some 15 125 (8.1 per cent) of the patients were admitted with a diagnosis of adhesions or had a procedure for division of adhesions. Overall, 3.5 per cent (6637 of 187 148) of patients underwent adhesiolysis. Patients selected for a laparoscopic procedure had lower rates of admission for adhesions (6.3 per cent (692 of 11 013) for laparoscopic versus 8.2 per cent (14 433 of 176 135) for open surgery; P < 0.001) and reintervention for adhesions (2.8 per cent (305 of 11 013) versus 3.6 per cent (6325 of 176 135) respectively; P < 0.001) than those undergoing an open procedure. In multiple regression analysis, patients selected for a laparoscopic procedure had lower subsequent intervention rates for adhesions (odds ratio 0.80, 95 per cent c.i. 0.71 to 0.90; P < 0.001). DISCUSSION: Patients undergoing colorectal resection who are selected for the laparoscopic approach have a lower risk o
Bottle A, Aylin P, Bell D, 2013, Predictors of readmission in heart failure patients vary by cause of readmission Hospital-level cause-specific readmission rates show no correlation, 2013 IEEE INTERNATIONAL CONFERENCE ON HEALTHCARE INFORMATICS (ICHI 2013), Pages: 563-566
King C, Alvarez LG, Holmes A, et al., 2012, Risk factors for healthcare-associated urinary tract infection and their applications in surveillance using hospital administrative data: a systematic review, JOURNAL OF HOSPITAL INFECTION, Vol: 82, Pages: 219-226, ISSN: 0195-6701
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- Citations: 21
Koshy E, Murray J, Bottle A, et al., 2012, Significantly increasing hospital admissions for acute throat infections among children in England: is this related to tonsillectomy rates?, ARCHIVES OF DISEASE IN CHILDHOOD, Vol: 97, Pages: 1064-1068, ISSN: 0003-9888
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- Citations: 16
Sharabiani MTA, Aylin P, Bottle A, 2012, Systematic Review of Comorbidity Indices for Administrative Data, MEDICAL CARE, Vol: 50, Pages: 1109-1118, ISSN: 0025-7079
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- Citations: 363
Palmer WL, Bottle A, Davie C, et al., 2012, Dying for the Weekend <i>A Retrospective Cohort Study on the Association Between Day of Hospital Presentation and the Quality and Safety of Stroke Care</i>, ARCHIVES OF NEUROLOGY, Vol: 69, Pages: 1296-1302, ISSN: 0003-9942
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- Citations: 83
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