Imperial College London

Dr David G. Lugo Palacios

Faculty of MedicineInstitute of Global Health Innovation

Honorary Research Fellow
 
 
 
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Contact

 

d.lugo-palacios Website

 
 
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Location

 

1003Queen Elizabeth the Queen Mother Wing (QEQM)St Mary's Campus

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Summary

 

Publications

Publication Type
Year
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23 results found

Lugo-Palacios DG, Clarke JM, Kristensen SR, 2023, Back to basics: A mediation analysis approach to addressing the fundamental questions of integrated care evaluations, HEALTH ECONOMICS, Vol: 32, Pages: 2080-2097, ISSN: 1057-9230

Journal article

Grieve R, Hutchings A, Zapata SM, Oneill S, Lugo-Palacios DG, Silverwood R, Cromwell D, Kircheis T, Silver E, Snowdon C, Charlton P, Bellingan G, Moonesinghe R, Keele L, Smart N, Hinchliffe Ret al., 2023, Clinical effectiveness and cost-effectiveness of emergency surgery for adult emergency hospital admissions with common acute gastrointestinal conditions: the ESORT study, Health and Social Care Delivery Research, Vol: 11, ISSN: 2755-0060

Background: Evidence is required on the clinical effectiveness and cost-effectiveness of emergency surgery compared with non-emergency surgery strategies (including medical management, non-surgical procedures and elective surgery) for patients admitted to hospital with common acute gastrointestinal conditions. Objectives: We aimed to evaluate the relative (1) clinical effectiveness of two strategies (i.e. emergency surgery vs. non-emergency surgery strategies) for five common acute conditions presenting as emergency admissions; (2) cost-effectiveness for five common acute conditions presenting as emergency admissions; and (3) clinical effectiveness and cost-effectiveness of the alternative strategies for specific patient subgroups. Methods: The records of adults admitted as emergencies with acute appendicitis, cholelithiasis, diverticular disease, abdominal wall hernia or intestinal obstruction to 175 acute hospitals in England between 1 April 2010 and 31 December 2019 were extracted from Hospital Episode Statistics and linked to mortality data from the Office for National Statistics. Eligibility was determined using International Statistical Classification of Diseases and Related Health Problems, Tenth Revision, diagnosis codes, which were agreed by clinical panel consensus. Patients having emergency surgery were identified from Office of Population Censuses and Surveys procedure codes. The study addressed the potential for unmeasured confounding with an instrumental variable design. The instrumental variable was each hospital’s propensity to use emergency surgery compared with non-emergency surgery strategies. The primary outcome was the ‘number of days alive and out of hospital’ at 90 days. We reported the relative effectiveness of the alternative strategies overall, and for prespecified subgroups (i.e. age, number of comorbidities and frailty level). The cost-effectiveness analyses used resource use and mortality from the linked data to derive

Journal article

Bidulka P, Mathur R, Lugo-Palacios DG, O'Neill S, Basu A, Silverwood RJ, Charlton P, Briggs A, Smeeth L, Adler A, Douglas IJ, Khunti K, Grieve Ret al., 2023, Ethnic and socioeconomic disparities in initiation of second-line antidiabetic treatment for people with type 2 diabetes in England: A cross-sectional study, DIABETES OBESITY & METABOLISM, Vol: 25, Pages: 282-292, ISSN: 1462-8902

Journal article

Moler-Zapata S, Grieve R, Lugo-Palacios D, Hutchings A, Silverwood R, Keele L, Kircheis T, Cromwell D, Smart N, Hinchliffe R, O'Neill Set al., 2022, Local Instrumental Variable Methods to Address Confounding and Heterogeneity when Using Electronic Health Records: An Application to Emergency Surgery, MEDICAL DECISION MAKING, Vol: 42, Pages: 1010-1026, ISSN: 0272-989X

Journal article

Hutchings A, O'Neill S, Lugo-Palacios D, Zapata SM, Silverwood R, Cromwell D, Keele L, Bellingan G, Moonesinghe SR, Smart N, Hinchliffe R, Grieve Ret al., 2022, Effectiveness of emergency surgery for five common acute conditions: an instrumental variable analysis of a national routine database, ANAESTHESIA, Vol: 77, Pages: 865-881, ISSN: 0003-2409

Journal article

Francetic I, Meacock R, Elliott J, Kristensen SR, Britteon P, Lugo-Palacios DG, Wilson P, Sutton Met al., 2022, Framework for identification and measurement of spillover effects in policy implementation: intended non-intended targeted non-targeted spillovers (INTENTS)., Implement Sci Commun, Vol: 3

BACKGROUND: There is increasing awareness among researchers and policymakers of the potential for healthcare interventions to have consequences beyond those initially intended. These unintended consequences or "spillover effects" result from the complex features of healthcare organisation and delivery and can either increase or decrease overall effectiveness. Their potential influence has important consequences for the design and evaluation of implementation strategies and for decision-making. However, consideration of spillovers remains partial and unsystematic. We develop a comprehensive framework for the identification and measurement of spillover effects resulting from changes to the way in which healthcare services are organised and delivered. METHODS: We conducted a scoping review to map the existing literature on spillover effects in health and healthcare interventions and used the findings of this review to develop a comprehensive framework to identify and measure spillover effects. RESULTS: The scoping review identified a wide range of different spillover effects, either experienced by agents not intentionally targeted by an intervention or representing unintended effects for targeted agents. Our scoping review revealed that spillover effects tend to be discussed in papers only when they are found to be statistically significant or might account for unexpected findings, rather than as a pre-specified feature of evaluation studies. This hinders the ability to assess all potential implications of a given policy or intervention. We propose a taxonomy of spillover effects, classified based on the outcome and the unit experiencing the effect: within-unit, between-unit, and diagonal spillover effects. We then present the INTENTS framework: Intended Non-intended TargEted Non-Targeted Spillovers. The INTENTS framework considers the units and outcomes which may be affected by an intervention and the mechanisms by which spillover effects are generated. CONC

Journal article

Gittins M, Lugo-Palacios D, Vail A, Bowen A, Paley L, Bray B, Tyson Set al., 2021, Stroke impairment categories: A new way to classify the effects of stroke based on stroke-related impairments, CLINICAL REHABILITATION, Vol: 35, Pages: 446-458, ISSN: 0269-2155

Journal article

Gittins M, Vail A, Bowen A, Lugo-Palacios D, Paley L, Bray B, Gannon B, Tyson Set al., 2020, Factors influencing the amount of therapy received during inpatient stroke care: an analysis of data from the UK Sentinel Stroke National Audit Programme, Clinical Rehabilitation, Vol: 34, Pages: 981-991, ISSN: 0269-2155

OBJECTIVES: To understand why most stroke patients receive little therapy. We investigated the factors associated with the amount of stroke therapy delivered. METHODS: Data regarding adults admitted to hospital with stroke for at least 72 hours (July 2013-July 2015) were extracted from the UK's Sentinel Stroke National Audit Programme. Descriptive statistics and multilevel mixed effects regression models explored the factors that influenced the amount of therapy received while adjusting for confounding. RESULTS: Of the 94,905 patients in the study cohort (mean age: 76 (SD: 13.2) years, 78% had a mild or moderate severity stroke. In all, 92% required physiotherapy, 87% required occupational therapy, 57% required speech therapy but only 5% were considered to need psychology. The average amount of therapy ranged from 2 minutes (psychology) to 14 minutes (physiotherapy) per day of inpatient stay. Unmodifiable characteristics (such as stroke severity) dominated the variation in the amount of therapy. However important, modifiable organizational factors were the day and time of admission, type of stroke team, timely therapy assessments, therapy and nursing staffing levels (qualified and support staff), and presence of weekend or early supported discharge services. CONCLUSION: The amount of stroke therapy is associated with unmodifiable patient-related characteristics and modifiable organizational factors in that more therapy was associated with higher therapy and nurse staffing levels, specialist stroke rehabilitation services, timely therapy assessments, and the presence of weekend and early discharge services.

Journal article

Gittins M, Lugo-Palacios D, Vail A, Bowen A, Paley L, Bray B, Gannon B, Tyson SFet al., 2020, Delivery, dose, outcomes and resource use of stroke therapy: the SSNAPIEST observational study, Health Services and Delivery Research

BACKGROUND:Therapy is key to effective stroke care, but many patients receive little. OBJECTIVES:To understand how stroke therapy is delivered in England, Wales and Northern Ireland, and which factors are associated with dose, outcome and resource use. DESIGN:Secondary analysis of the Sentinel Stroke National Audit Programme, using standard descriptive statistics and multilevel mixed-effects regression models, while adjusting for all known and measured confounders. SETTING:Stroke services in England, Wales and Northern Ireland. PARTICIPANTS:A total of 94,905 adults admitted with stroke, who remained an inpatient for > 72 hours. RESULTS:Routes through stroke services were highly varied (> 800), but four common stroke pathways emerged. Seven distinct impairment-based patient subgroups were characterised. The average amount of therapy was very low. Modifiable factors associated with the average amount of inpatient therapy were type of stroke team, timely therapy assessments, staffing levels and model of therapy provision. More (of any type of) therapy was associated with shorter length of stay, less resource use and lower mortality. More occupational therapy, speech therapy and psychology were also associated with less disability and institutionalisation. Large amounts of physiotherapy were associated with greater disability and institutionalisation. LIMITATIONS:Use of observational data does not infer causation. All efforts were made to adjust for all known and measured confounding factors but some may remain. We categorised participants using the National Institutes of Health Stroke Scale, which measures a limited number of impairments relatively crudely, so mild or rare impairments may have been missed. CONCLUSIONS:Stroke patients receive very little therapy. Modifiable organisational factors associated with greater amounts of therapy were identified, and positive associations between amount of therapy and outcome were confirmed. The reason for t

Journal article

Gittins M, Lugo-Palacios DG, Paley L, Bray B, Bowen A, Vail A, Gannon B, Tyson Set al., 2020, How do patients pass through stroke services? Identifying stroke care pathways using national audit data, CLINICAL REHABILITATION, Vol: 34, Pages: 698-709, ISSN: 0269-2155

Journal article

Lugo-Palacios DG, Gannon B, Gittins M, Vail A, Bowen A, Tyson Set al., 2019, Variations in hospital resource use across stroke care teams in England, Wales and Northern Ireland: a retrospective observational study, BMJ Open, Vol: 9, Pages: 1-11, ISSN: 2044-6055

Objective To identify the main drivers of inpatient stroke care resource use, estimate the influence of stroke teams on the length of stay (LoS) of its patients and analyse the variation in relative performance across teams.Design For each of four types of stroke care teams, a two-level count data model describing the variation in LoS and identifying the team influence on LoS purged of patient and treatment characteristics was estimated. Each team effect was interpreted as a measure of stroke care relative performance and its variation was analysed.Setting This study used data from 145 396 admissions in 256 inpatient stroke care teams between June 2013 and July 2015 included in the national stroke register of England, Wales and Northern Ireland—Sentinel Stroke National Audit Programme.Results The main driver of LoS, and thus resource use, was the need for stroke therapy even after stroke severity was taken into account. Conditional on needing the therapy in question, an increase in the average amount of therapy received per inpatient day was associated with shorter LoS. Important variations in stroke care performance were found within each team category.Conclusions Resource use was strongly associated with stroke severity, the need for therapy and the amount of therapy received. The variations in stroke care performance were not explained by measurable patient or team characteristics. Further operational and financial analyses are needed to unmask the causes of this unexplained variation.

Journal article

Lugo-Palacios DG, Hammond J, Allen T, Darley S, McDonald R, Blakeman T, Bower Pet al., 2019, The impact of a combinatorial digital and organisational intervention on the management of long-term conditions in UK primary care: a non-randomised evaluation, BMC HEALTH SERVICES RESEARCH, Vol: 19, ISSN: 1472-6963

Journal article

Gittins M, Vail A, Bowen A, Lugo-Palacios DG, Tyson Set al., 2018, What factors impact on the intensity of therapy stroke survivors receive? The Sentinel Stroke National Audit Programme (SSNAP): investigating and evaluating stoke therapy (SSNAPIEST), Publisher: SAGE PUBLICATIONS LTD, Pages: 52-52, ISSN: 1747-4930

Conference paper

Gittins M, Vail A, Bowen A, Lugo-Palacios DG, Paley L, Bray B, Tyson Set al., 2018, Identifying stroke care pathways in the UK using the Sentinel Stroke National Audit Programme, Publisher: SAGE PUBLICATIONS LTD, Pages: 19-19, ISSN: 1747-4930

Conference paper

Marie Knaul F, Arreola-Ornelas H, Wong R, Lugo-Palacios DG, Mendez-Carniado Oet al., 2018, The effect of <i>Seguro Popular de Salud</i> on catastrophic and impoverishing expenditures in Mexico, 2004-2012, SALUD PUBLICA DE MEXICO, Vol: 60, Pages: 130-140, ISSN: 0036-3634

Journal article

Lugo-Palacios DG, Gannon B, 2017, Health care utilisation amongst older adults with sensory and cognitive impairments in Europe, HEALTH ECONOMICS REVIEW, Vol: 7, ISSN: 2191-1991

Journal article

Lugo-Palacios DG, Cairns J, Masetto C, 2016, Measuring the burden of preventable diabetic hospitalisations in the Mexican Institute of Social Security (IMSS), BMC HEALTH SERVICES RESEARCH, Vol: 16

Journal article

Lugo-Palacios DG, Cairns J, 2016, The financial and health burden of diabetic ambulatory care sensitive hospitalisations in Mexico, SALUD PUBLICA DE MEXICO, Vol: 58, Pages: 33-40, ISSN: 0036-3634

Journal article

Lugo-Palacios DG, Cairns J, 2015, Using ambulatory care sensitive hospitalisations to analyse the effectiveness of primary care services in Mexico, SOCIAL SCIENCE & MEDICINE, Vol: 144, Pages: 59-68, ISSN: 0277-9536

Journal article

Ardila-Gomez S, Lugo-Palacios DG, Vargas-Palacios E, 2015, Linking research and policies in Latin America and the Caribbean: the case of violence, GLOBAL HEALTH PROMOTION, Vol: 22, Pages: 74-76, ISSN: 1757-9759

Journal article

Ardila-Gomez S, Lugo-Palacios DG, Vargas-Palacios E, 2015, Marrying research evidence and policies in Latin America and the Caribbean: the case of violence, GLOBAL HEALTH PROMOTION, Vol: 22, Pages: 6-7, ISSN: 1757-9759

Journal article

Ardila-Gomez S, Lugo-Palacios DG, Vargas-Palacios E, 2015, Connecting research and politics in Latin America and the Caribbean: the case of violence, GLOBAL HEALTH PROMOTION, Vol: 22, Pages: 97-99, ISSN: 1757-9759

Journal article

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