Publications
255 results found
Evans L, Green S, Howe C, et al., 2014, Improving patient and project outcomes using interorganisational innovation, collaboration and co-design., London J Prim Care (Abingdon), Vol: 6, Pages: 29-34, ISSN: 1757-1472
Background Common mental disorders (CMDs) are a leading cause of disability. The Department of Health has launched a large-scale initiative to improve access to evidence-based psychological treatments, such as cognitive behavioural therapy (CBT), through the Improving Access to Psychological Therapy (IAPT) programme. Access to IAPT services by black and minority ethnic (BME) communities is lower than for other groups. Setting The London Borough of Ealing in west London; a diverse borough with areas of high BME population and relatively high deprivation. Aim To compare the outcomes of two linked quality improvement (QI) projects undertaken by Ealing Mental Health and Wellbeing Service (MHWBS), both with the same aim of increasing access to talking therapies for BME communities. Methods Application of QI methodologies supported by the NIHR CLAHRC for northwest London in two different settings in Ealing. One, the 'Southall project', was set within a wider initiative for collaborative improvements and shared learning (the Southall Initiative for Integrated Care) in an ethnically diverse area of Ealing; it was undertaken between April 2010 and September 2011. The second, 'the Ealing project', operated in the two other Ealing localities that did not have the advantage of a broader initiative for collaborative improvements; it was undertaken between April 2011 and September 2012. Results Comparison of the monthly referral rates of BME patients (standardised per 10 000 general practitioner (GP)-registered patients) show that the Southall project was more effective in increasing referrals from BME communities than the Ealing project. Conclusion Broad local participation and ownership in the project design of the Southall project may explain why it was more effective in achieving its aims than the Ealing project which lacked these ownership-creating mechanisms.
Laverty AA, Elkin SL, Watt H, et al., 2013, Implementation of a COPD discharge care bundle and hospital readmissions in london, British Thoracic Society Winter Meeting 2013
Sullivan P, Harris ML, Bell D, 2013, The quality of patient experience of short-stay acute medical admissions: findings of the Adult Inpatient Survey in England, CLINICAL MEDICINE, Vol: 13, Pages: 553-556, ISSN: 1470-2118
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- Citations: 9
Fleming SL, Jones SE, Green S, et al., 2013, PATIENTS' EXPERIENCES OF EARLY POST-HOSPITALISATION PULMONARY REHABILITATION: A QUALITY IMPROVEMENT INITIATIVE, Winter Meeting of the British-Thoracic-Society, Publisher: BMJ PUBLISHING GROUP, Pages: A94-A94, ISSN: 0040-6376
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- Citations: 1
AlJuburi G, Laverty AA, Green SA, et al., 2013, Socio-economic deprivation and risk of emergency readmission and inpatient mortality in people with sickle cell disease in England: observational study, Journal of Public Health
Doyle C, Howe C, Woodcock T, et al., 2013, Making change last: applying the NHS institute for innovation and improvement sustainability model to healthcare improvement., Implementation Science, Vol: 8, ISSN: 1748-5908
The implementation of evidence-based treatments to deliver high-quality care is essential to meet the healthcare demands of aging populations. However, the sustainable application of recommended practice is difficult to achieve and variable outcomes well recognised. The NHS Institute for Innovation and Improvement Sustainability Model (SM) was designed to help healthcare teams recognise determinants of sustainability and take action to embed new practice in routine care. This article describes a formative evaluation of the application of the SM by the National Institute for Health Research Collaboration for Leadership in Applied Health Research and Care for Northwest London (CLAHRC NWL). Data from project teams' responses to the SM and formal reviews was used to assess acceptability of the SM and the extent to which it prompted teams to take action. Projects were classified as 'engaged,' 'partially engaged' and 'non-engaged.' Quarterly survey feedback data was used to explore reasons for variation in engagement. Score patterns were compared against formal review data and a 'diversity of opinion' measure was derived to assess response variance over time. Of the 19 teams, six were categorized as 'engaged,' six 'partially engaged,' and seven as 'non-engaged.' Twelve teams found the model acceptable to some extent. Diversity of opinion reduced over time. A minority of teams used the SM consistently to take action to promote sustainability but for the majority SM use was sporadic. Feedback from some team members indicates difficulty in understanding and applying the model and negative views regarding its usefulness. The SM is an important attempt to enable teams to systematically consider determinants of sustainability, provide timely data to assess progress, and prompt action to create conditions for sustained practice. Tools such as these need to be tested in healthcare settings to assess strengths and weaknesses and findings disseminated to aid development. This study
Luchenski SA, Reed JE, Marston C, et al., 2013, Patient and Public Views on Electronic Health Records and Their Uses in the United Kingdom: Cross-Sectional Survey, JOURNAL OF MEDICAL INTERNET RESEARCH, Vol: 15, ISSN: 1438-8871
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- Citations: 38
Sullivan PJ, Harris ML, Doyle C, et al., 2013, Assessment of the validity of the English National Health Service Adult In-Patient Survey for use within individual specialties, BMJ QUALITY & SAFETY, Vol: 22, Pages: 690-696, ISSN: 2044-5415
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- Citations: 2
Soong J, Balasanthiran A, MacLeod DC, et al., 2013, National survey of patients with AF in the acute medical unit: A day in the life survey, British Journal of Cardiology, Vol: 20, ISSN: 0969-6113
Atrial fibrillation (AF) is the most common cardiac dysrrhythmia. The evidence base and expert consensus opinion for management have been summarised in several international guidelines. Recent studies suggest a disparity between contemporary practice and perceived best practice. An electronic questionnaire was constructed to capture details of patient demographics and current practice, including risk assessment for stroke and major bleeding. All patients >18 years with AF as a primary or secondary diagnosis admitted from midday on the 14th September 2011 to midday on the 15th September 2011, were included in the survey. Participating units were recruited from the Society for Acute Medicine registry, and provided with an electronic link and password to enter data for individual patient episodes. The electronic questionnaire was completed for 149 patient episodes from 31 acute medical units (AMUs) across the UK. The typical patient with AF presenting to the AMU is older, has important medical comorbidities (sepsis in almost a third) and frequently presents out of hours. Initial management was digoxin alone in 22% and 23% had a documented stroke risk assessment, not in-keeping with current guidelines. This relatively simple methodology yields valuable insight into the real world management of AF, providing an additional evidence base.
Woodcock T, Poots AJ, Bell D, 2013, The impact of changing the 4 h emergency access standard on patient waiting times in emergency departments in England, Emergency Medicine Journal
Bell D, Lambourne A, Percival F, et al., 2013, Consultant Input in Acute Medical Admissions and Patient Outcomes in Hospitals in England: A Multivariate Analysis, PLOS One, Vol: 8, ISSN: 1932-6203
Recent recommendations for physicians in the UK outline key aspects of care that should improve patient outcomes and experience in acute hospital care. Included in these recommendations are Consultant patterns of work to improve timeliness of clinical review and improve continuity of care. This study used a contemporaneous validated survey compared with clinical outcomes derived from Hospital Episode Statistics, between April 2009 and March 2010 from 91 acute hospital sites in England to evaluate systems of consultant cover for acute medical admissions. Clinical outcomes studied included adjusted case fatality rates (aCFR), including the ratio of weekend to weekday mortality, length of stay and readmission rates. Hospitals that had an admitting Consultant presence within the Acute Medicine Unit (AMU, or equivalent) for a minimum of 4 hours per day (65% of study group) had a lower aCFR compared with hospitals that had Consultant presence for less than 4 hours per day (p<0.01) and also had a lower 28 day re-admission rate (p<0.01). An ‘all inclusive’ pattern of Consultant working, incorporating all the guideline recommendations and which included the minimum Consultant presence of 4 hours per day (29%) was associated with reduced excess weekend mortality (p<0.05). Hospitals with >40 acute medical admissions per day had a lower aCFR compared to hospitals with fewer than 40 admissions per day (p<0.03) and had a lower 7 day re-admission rate (p<0.02). This study is the first large study to explore the potential relationships between systems of providing acute medical care and clinical outcomes. The results show an association between well-designed systems of Consultant working practices, which promote increased patient contact, and improved patient outcomes in the acute hospital setting.
Balasanthiran A, Papoutsi C, Shotliff K, et al., 2013, The power of information for diabetes research and self-care patient views in Northwest London, DIABETIC MEDICINE, Vol: 30, Pages: 126-126, ISSN: 0742-3071
Howe C, Randall K, Chalkley S, et al., 2013, Supporting improvement in a quality collaborative, British Journal of Health Care Management, Vol: 19, Pages: 434-442, ISSN: 1358-0574
Quality improvement collaboratives seek to address the mandate to improve healthcare quality and reduce inappropriate variations in care through the use of defined methods and change concepts. There are indications of positive effects, but less evidence of the effectiveness of the methods - the 'black box' of the intervention - and how to effectively implement a collaborative. This study uses an assessment framework to quantify engagement with and uptake of collaborative methodology in 17 projects in a quality improvement collaborative in North West London. The framework developed by the NIHR CLAHRC for Northwest London showed variation in uptake and use of methods within and across projects. For example, most projects involved patients and the public and disseminated learning. There was more limited engagement with the NHS Institute for Innovation and Improvement Sustainability Model. The framework provides detailed methods-related information that collaborative leaders could use for generative learning to meet participants' needs, and identify peer exemplars. This study raises important questions about implementation fidelity and highlights the need to open the 'black box' both while the work is in progress to allow generative learning, and for the purposes of evaluation. © 2013 MA Healthcare Ltd.
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
Doyle C, Lennox L, Bell D, 2013, A systematic review of evidence on the links between patient experience and clinical safety and effectiveness, BMJ OPEN, Vol: 3, ISSN: 2044-6055
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- Citations: 1172
Subbe CP, Ward D, Latip L, et al., 2013, A day in the life of the AMU--the Society for Acute Medicine's benchmarking audit 2012 (SAMBA '12)., Acute Med, Vol: 12, Pages: 69-73
BACKGROUND: The absence of published data for benchmarking serves as a disincentive for Acute Medical Units to improve care. AIM: To test feasibility of a national audit in Acute Medicine for compliance with common standards. METHODS: On line questionnaire with summary data for patients admitted to participating Acute Medicine Units over a 24-hour-period. RESULTS: 30 units submitted summary data. The mean number of admission was 36 (SD 14). Compliance with standards around timing of junior and senior review was highly variable. In almost all other standards only a small number of units achieved high reliability with compliance of more than 90%. CONCLUSION: SAMBA provides a data set that can be used for local and national benchmarking and quality improvement work. Annual audit might be beneficial to track improvements.
Webster S, Shotliff K, Sharma U, et al., 2012, Doctors on television: analysis of doctors' experiences during filming of a documentary in the workplace., BMJ, Vol: 345
Poots AJ, Green SA, Barnes R, et al., 2012, Using routine geo-coded data to identify geographical heterogeneity to reduce disparities: case studies in UK., Proceedings of the First ACM SIGSPATIAL International Workshop on Use of GIS in Public Health, Pages: 40-43
Thomson AD, Marshall EJ, Bell D, 2012, Time to Act on the Inadequate Management of Wernicke's Encephalopathy in the UK, ALCOHOL AND ALCOHOLISM, Vol: 48, Pages: 4-8, ISSN: 0735-0414
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- Citations: 24
Green S, Sullivan P, Bell D, et al., 2012, Aligning quality improvement to population health, INTERNATIONAL JOURNAL FOR QUALITY IN HEALTH CARE, Vol: 24, Pages: 441-442, ISSN: 1353-4505
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- Citations: 2
Patterson CM, Ahmed N, Nicol ED, et al., 2012, Do United Kingdom guidelines for the assessment of suspected angina underestimate the likelihood of coronary artery disease and major adverse cardiac events?, Congress of the European-Society-of-Cardiology (ESC), Publisher: Oxford University Press, Pages: 960-961, ISSN: 0195-668X
AlJuburi G, Laverty AA, Green S, et al., 2012, Trends in hospital admissions for Sickle Cell Disease in England, 2001/02 to 2009/10, Journal of Public Health
Luchenski S, Balasanthiran A, Marston C, et al., 2012, Survey of patient and public perceptions of electronic health records for healthcare, policy and research: Study protocol, BMC Medical Informatics and Decision Making, Vol: 12, ISSN: 1472-6947
Background: Immediate access to patients’ complete health records via electronic databases could improvehealthcare and facilitate health research. However, the possible benefits of a national electronic health records(EHR) system must be balanced against public concerns about data security and personal privacy. Successfuldevelopment of EHR requires better understanding of the views of the public and those most affected by EHR:users of the National Health Service. This study aims to explore the correlation between personal healthcareexperience (including number of healthcare contacts and number and type of longer term conditions) and viewsrelating to development of EHR for healthcare, health services planning and policy and health research.Methods/design: A multi-site cross-sectional self-complete questionnaire designed and piloted for use in waitingrooms was administered to patients from randomly selected outpatients’ clinics at a university teaching hospital(431 beds) and general practice surgeries from the four primary care trusts within the catchment area of thehospital. All patients entering the selected outpatients clinics and general practice surgeries were invited totake part in the survey during August-September 2011. Statistical analyses will be conducted using descriptivetechniques to present respondents’ overall views about electronic health records and logistic regression to exploreassociations between these views and participants’ personal circumstances, experiences, sociodemographics andmore specific views about electronic health records.Discussion: The study design and implementation were successful, resulting in unusually high response rates andoverall recruitment (85.5%, 5336 responses). Rates for face-to-face recruitment in previous work are variable, buttypically lower (mean 76.7%, SD 20). We discuss details of how we collected the data to provide insight into howwe obtained this unusually high response rate.
Patterson C, Ahmed N, Nicol E, et al., 2012, Clinical outcomes of patients excluded from cardiac investigation in the NICE guidelines for chest pain of recent onset, Annual Conference of the British-Cardiovascular-Society (BCS), Publisher: BMJ Publishing Group, Pages: A78-A78, ISSN: 1355-6037
Curcin V, Woodcock T, Reed JE, et al., 2012, CLAHRC Healthcare Improvement Support System (HISS), Pages: 867-870
This demo presents the main features of the CLAHRC Healthcare Improvement Support System (HISS), a data collection and reporting toolkit which has been designed as a collaboration between the Department of Computing at Imperial College London and NIHR CLAHRC [3] initiative to facilitate measurement for improvement in local multidisciplinary healthcare improvement teams. The HISS software toolkit is supporting a larger methodology to implement research into practice through a series of quality improvement projects and managing the design, introduction, spread and sustainability of those improvements. It allows the project teams to design the desired process model, define quantitative improvement measures, and automatically generate a web application for the team members to enter measurement data at regular (typically weekly) intervals, and monitor their progress in real-time.The demo will showcase some common functions of the system on the example of a real-life improvement project. Copyright © 2012 ACM.
Wachter RM, Bell D, 2012, Renaissance of hospital generalists, BMJ-BRITISH MEDICAL JOURNAL, Vol: 344, ISSN: 1756-1833
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- Citations: 28
Vaughan L, Bell D, McAlister G, 2012, Impact of the "July Effect" on Patient Outcomes, ANNALS OF INTERNAL MEDICINE, Vol: 156, Pages: 167-168, ISSN: 0003-4819
Khamis RY, 2012, Oxford Desk Reference: Acute Medicine, Oxford Desk Reference: Acute Medicine, Editors: Leach, Moore, Bell, ISBN: 9780199565979
Bell D, Ward D, Percival F, et al., 2012, An evaluation of Consultant input into acute medical admissions management in England
Hopkinson NS, Englebretsen C, Cooley N, et al., 2012, Designing and implementing a COPD discharge care bundle., Thorax, Vol: 67, Pages: 90-92
National surveys have revealed significant differences in patient outcomes following admission to hospital with acute exacerbation of COPD which are likely to be due to variations in care. We developed a care bundle, comprising a short list of evidence-based practices to be implemented prior to discharge for all patients admitted with this condition, based on a review of national guidelines and other relevant literature, expert opinion and patient consultation. Implementation was then piloted using action research methodologies with patient input. Actively involving staff was vital to ensure that the changes introduced were understood and the process followed. Implementation of a care bundle has the potential to produce a dramatic improvement in compliance with optimum health care practice.
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