Publications
152 results found
Greaves F, Laverty AA, Ramirez Cano D, et al., 2014, Tweets about hospital quality: a mixed methods study, BMJ Quality & Safety, Vol: 23, Pages: 838-846, ISSN: 2044-5423
Background Twitter is increasingly being used by patients to comment on their experience of healthcare. This may provide information for understanding the quality of healthcare providers and improving services.Objective To examine whether tweets sent to hospitals in the English National Health Service contain information about quality of care. To compare sentiment on Twitter about hospitals with established survey measures of patient experience and standardised mortality rates.Design A mixed methods study including a quantitative analysis of all 198 499 tweets sent to English hospitals over a year and a qualitative directed content analysis of 1000 random tweets. Twitter sentiment and conventional quality metrics were compared using Spearman's rank correlation coefficient.Key results 11% of tweets to hospitals contained information about care quality, with the most frequent topic being patient experience (8%). Comments on effectiveness or safety of care were present, but less common (3%). 77% of tweets about care quality were positive in tone. Other topics mentioned in tweets included messages of support to patients, fundraising activity, self-promotion and dissemination of health information. No associations were observed between Twitter sentiment and conventional quality metrics.Conclusions Only a small proportion of tweets directed at hospitals discuss quality of care and there was no clear relationship between Twitter sentiment and other measures of quality, potentially limiting Twitter as a medium for quality monitoring. However, tweets did contain information useful to target quality improvement activity. Recent enthusiasm by policy makers to use social media as a quality monitoring and improvement tool needs to be carefully considered and subjected to formal evaluation.
Greaves F, Laverty A, Ramirez-Cano D, et al., 2014, ANALYSIS OF PATIENTS' COMMENTS ABOUT HOSPITALS IN THE ENGLISH NHS VIA TWITTER, AND COMPARISON WITH PATIENT SURVEYS, BMJ QUALITY & SAFETY, Vol: 23, ISSN: 2044-5415
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- Citations: 4
Greaves F, 2013, TELL US HOW IT WAS FOR YOU Whose role is it to collect patients' stories?, BMJ-BRITISH MEDICAL JOURNAL, Vol: 347, ISSN: 1756-1833
Greaves F, Ramirez-Cano D, Millett C, et al., 2013, Use of Sentiment Analysis for Capturing Patient Experience From Free-Text Comments Posted Online, JOURNAL OF MEDICAL INTERNET RESEARCH, Vol: 15, ISSN: 1438-8871
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- Citations: 164
Harris M, Greaves F, Gunn L, et al., 2013, Multidisciplinary integration in the context of integrated care - results from the North West London Integrated Care Pilot, INTERNATIONAL JOURNAL OF INTEGRATED CARE, Vol: 13, ISSN: 1568-4156
Background:In the context of integrated care, Multidisciplinary Group meetings involve participants from diverse professional groupsand organisations and are potential vehicles to advance efficiency improvements within the local health economy. We advance a novelmethod to characterise the communication within Multidisciplinary Group meetings measuring the extent to which participants integrateand whether this integration leads to improved working.Methods:We purposively selected four Multidisciplinary Group meetings and conducted a content analysis of audio-recorded and tran-scribed Case Discussions. Two coders independently coded utterances according to their‘integrative intensity’which was defined againstthree a-priori independent domains - the Level (i.e. Individual, Collective and Systems); the Valence (Problem, Information and Solution);the Focus (Concrete and Abstract). Inter- and intra-rater reliability was tested with Kappa scores on one randomly selected Case Discus-sion. Standardised weighted mean integration scores were calculated for Case Discussions across utterance deciles, indicating how inte-grative intensity changed during the conversations.Results:Twenty-three Case Discussions in four different Multidisciplinary Groups were transcribed and coded. Inter- and intra-rater relia-bility was good as shown by the Prevalence and Bias-Adjusted Kappa Scores for one randomly selected Case Discussion. There were differences in the proportion of utterances per participant type (Consultant 14.6%; presenting general practitioner 38.75%; Chair 7.8%; non-presenting general practitioner 2.25%; Allied Health Professional 4.8%). Utterances were predominantly coded at low levels of integrativeintensity; however, there was a gradual increase (R2= 0.71) in integrative intensity during the Case Discussions. Based on the analysis ofthe minutes and action points arising from the Case Discussions, this improved integration did not translate into actions moving for
Beck CR, McKenzie BC, Hashim AB, et al., 2013, Influenza vaccination for immunocompromised patients: summary of a systematic review and meta-analysis, Influenza and Other Respiratory Viruses, Vol: 7, Pages: 72-75, ISSN: 1750-2640
Vaccination of immunocompromised patients is recommended in many national guidelines to protect against severe or complicated influenza infection. However, due to uncertainties over the evidence base, implementation is frequently patchy and dependent on individual clinical discretion. We conducted a systematic review and meta‐analysis to assess the evidence for influenza vaccination in this patient group. Healthcare databases and grey literature were searched and screened for eligibility. Data extraction and assessments of risk of bias were undertaken in duplicate, and results were synthesised narratively and using meta‐analysis where possible. Our data show that whilst the serological response following vaccination of immunocompromised patients is less vigorous than in healthy controls, clinical protection is still meaningful, with only mild variation in adverse events between aetiological groups. Although we encountered significant clinical and statistical heterogeneity in many of our meta‐analyses, we advocate that immunocompromised patients should be targeted for influenza vaccination.
Greaves F, Laverty AA, Millett C, 2013, FRIENDS AND FAMILY TEST Friends and family test results only moderately associated with conventional measures of hospital quality, BMJ-BRITISH MEDICAL JOURNAL, Vol: 347, ISSN: 1756-1833
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- Citations: 6
Curry N, Harris M, Gunn LH, et al., 2013, Integrated care pilot in north west London: a mixed methods evaluation, International Journal of Integrated Care, Vol: 13, ISSN: 1568-4156
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
Greaves F, Donaldson L, 2013, Measles in the UK: a test of public health competency in a crisis, BMJ-BRITISH MEDICAL JOURNAL, Vol: 346, ISSN: 1756-1833
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- Citations: 4
King D, Greaves F, Vlaev I, et al., 2013, Approaches based on behavioral economics could help nudge patients and providers toward lower health spending growth., Health Aff (Millwood), Vol: 32, Pages: 661-668
Greaves F, Pappas Y, Bardsley M, et al., 2013, Evaluation of complex integrated care programmes: the approach in North West London, International Journal of Integrated Care, Vol: 13, ISSN: 1568-4156
Background: Several local attempts to introduce integrated care in the English National Health Service have been tried, with limited success. The Northwest London Integrated Care Pilot attempts to improve the quality of care of the elderly and people with diabetes by providing a novel integration process across primary, secondary and social care organisations. It involves predictive risk modelling, care planning, multidisciplinary management of complex cases and an information technology tool to support information sharing. This paper sets out the evaluation approach adopted to measure its effect. Study design: We present a mixed methods evaluation methodology. It includes a quantitative approach measuring changes in service utilization, costs, clinical outcomes and quality of care using routine primary and secondary data sources. It also contains a qualitative component, involving observations, interviews and focus groups with patients and professionals, to understand participant experiences and to understand the pilot within the national policy context. Theory and discussion: This study considers the complexity of evaluating a large, multi-organisational intervention in a changing healthcare economy. We locate the evaluation within the theory of evaluation of complex interventions. We present the specific challenges faced by evaluating an intervention of this sort, and the responses made to mitigate against them. Conclusions: We hope this broad, dynamic and responsive evaluation will allow us to clarify the contribution of the pilot, and provide a potential model for evaluation of other similar interventions. Because of the priority given to the integrated agenda by governments internationally, the need to develop and improve strong evaluation methodologies remains strikingly important.
King D, Greaves F, Exeter C, et al., 2013, 'Gamification': Influencing health behaviours with games, JOURNAL OF THE ROYAL SOCIETY OF MEDICINE, Vol: 106, Pages: 76-78, ISSN: 0141-0768
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- Citations: 161
Harris M, Greaves F, Gunn L, et al., 2013, Multidisciplinary group performance – measuring integration intensity in the context of the North West London Integrated Care Pilot, International Journal of Integrated Care, Vol: 13, ISSN: 1568-4156
Introduction: Multidisciplinary Group meeting (MDGs) are seen as key facilitators of integration, moving from individual to multi-disciplinary decision making, and from a focus on individual patients to a focus on patient groups. We have developed a method for coding MDG transcripts to identify whether they are or are not vehicles for delivering the anticipated efficiency improvements across various providers and apply it to a test case in the North West London Integrated Care Pilot. Methods: We defined 'integrating' as the process within the MDG meeting that enables or promotes an improved collaboration, improved understanding, and improved awareness of self and others within the local healthcare economy such that efficiency improvements could be identified and action taken. Utterances within the MDGs are coded according to three distinct domains grounded in concepts from communication, group decision-making, and integrated care literatures - the Valence, the Focus, and the Level. Standardized weighted integrative intensity scores are calculated across ten time deciles in the Case Discussion providing a graphical representation of its integrative intensity.Results: Intra- and Inter-rater reliability of the coding scheme was very good as measured by the Prevalence and Bias-adjusted Kappa Score. Standardized Weighted Integrative Intensity graph mirrored closely the verbatim transcript and is a convenient representation of complex communication dynamics. Trend in integrative intensity can be calculated and the characteristics of the MDG can be pragmatically described.Conclusion: This is a novel and potentially useful method for researchers, managers and practitioners to better understand MDG dynamics and to identify whether participants are integrating. The degree to which participants use MDG meetings to develop an integrated way of working is likely to require management, leadership and shared values.
Greaves F, Guest C, 2013, Workforce, Oxford Handbook of Public Health Practice, Editors: Guest, Ricciardi, Kawachi, Lang, Publisher: OUP Oxford, ISBN: 9780199586301
Fully revised and updated for the third edition, the Oxford Handbook of Public Heath Practice remains the first resort for all those working in this broad field.
Guest C, MacKay K, Greaves F, 2013, A chronology of public health practice, Oxford Handbook of Public Health Practice, Editors: Guest, Ricciardi, Kawachi, Lang, Publisher: OUP Oxford, ISBN: 9780199586301
Fully revised and updated for the third edition, the Oxford Handbook of Public Heath Practice remains the first resort for all those working in this broad field.
Hamilton FL, Greaves F, Majeed A, et al., 2013, Effectiveness of providing financial incentives to healthcare professionals for smoking cessation activities: systematic review, TOBACCO CONTROL, Vol: 22, Pages: 3-8, ISSN: 0964-4563
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- Citations: 29
King D, Ramirez-Cano D, Greaves F, et al., 2013, Twitter and the health reforms in the English National Health Service, Health Policy, Vol: 110, Pages: 291-297, ISSN: 0168-8510
Social media (for example Facebook and YouTube) uses online and mobile technologies to allow individuals to participate in, comment on and create user-generated content. Twitter is a widely used social media platform that lets users post short publicly available text-based messages called tweets that other users can respond to. Alongside traditional media outlets, Twitter has been a focus for discussions about the controversial and radical reforms to the National Health Service (NHS) in England that were recently passed into law by the current coalition Government. Looking at over 120,000 tweets made about the health reforms, we have investigated whether any insights can be obtained about the role of Twitter in informing, debating and influencing opinion in a specific area of health policy. In particular we have looked at how the sentiment of tweets changed with the passage of the Health and Social Care Bill through Parliament, and how this compared to conventional opinion polls taken over the same time period. We examine which users appeared to have the most influence in the ‘Twittersphere’ and suggest how a widely used metric of academic impact – the H-index – could be applied to measure context-dependent influence on Twitter.
Greaves F, Ramirez Cano D, Millett C, et al., 2013, Harnessing the cloud of patient experience: using social media to detect poor quality healthcare., BMJ Qual Saf
King D, Greaves F, Vlaev I, et al., 2013, Approaches Based On Behavioral Economics Could Help Nudge Patients And Providers Toward Lower Health Spending Growth, Health Affairs, Vol: 32, Pages: 661-668
Greaves F, Ramirez-Cano D, Millett C, et al., 2012, Machine learning and sentiment analysis of unstructured free-text information about patient experience online, Lancet, Vol: 380, ISSN: 0140-6736
Traditional measures of patient experience have included surveys and, more recently, structured patient-reported outcome measures. There are also large amounts of unstructured, free-text information about the quality of health care available on the internet from blogs, social networks, and health-care rating websites that we are not scrutinising. In other industries, real-time natural language processing, such as sentiment analysis, of large datasets has provided a useful analytical approach to find patterns and understand data. If these techniques can be applied to health care, it opens up a novel approach to analyse large volumes of textual information about patient experience. The large number of free-text comments on the UK NHS Choices website allows an opportunity to examine these data through sentiment analysis. These comments are matched with the users' own quantitative ratings of the service, presenting an opportunity to measure the accuracy of natural language processing methods against the patient's own assessment. Simultaneously, the NHS has a developed programme of patient experience measurement via a national survey of hospital inpatients. Using these data sources, we have a natural opportunity to compare our sentiment analysis of comments to traditional patient surveys at an organisational level. We tried to predict whether a patient would recommend a hospital, whether the hospital was clean, and whether they were treated with dignity from their free-text descriptions. We applied machine learning and natural language processing techniques to all (6400) online comments about hospitals on the NHS Choices website in 2010. We used open-source Weka data mining software. We used comments from NHS Choices data from 2008, 2009, and 2011 to train the software. Data from 2010 were used to test the predicting accuracy of the approach. We included our own a priori classification of the 1000 most common words and phrases in the analysis. Having calculated the accur
Finlayson AET, Greaves F, Ali FR, 2012, Technologies for global health, LANCET, Vol: 380, Pages: 1739-1739, ISSN: 0140-6736
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- Citations: 12
Greaves F, Pape U, Lee H, et al., 2012, Patients' ratings of family physician practices on the internet: usage and associations with conventional measures of quality in the English National Health Service., J Med Internet Res, Vol: 5
Beck CR, McKenzie BC, Hashim AB, et al., 2012, Influenza Vaccination for Immunocompromised Patients: Systematic Review and Meta-analysis by Etiology, JOURNAL OF INFECTIOUS DISEASES, Vol: 206, Pages: 1250-1259, ISSN: 0022-1899
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- Citations: 96
Bowen J, Southgate R, Ali A, et al., 2012, Can UK healthcare workers remotely support medical education in the developing world?: Focus group evaluation, JRSM Short Reports, Vol: 3, Pages: 1-6, ISSN: 2042-5333
OBJECTIVES: To evaluate the feasibility of providing regular, live, text-based teaching to medical students and junior doctors in Somaliland using a dedicated case-based medical education website (www.MedicineAfrica.com). DESIGN: Review of MedicineAfrica database for details of teaching sessions held in Somaliland from December 2008-October 2010 and evaluation of user experiences through focus groups. SETTING: King's College Hospital, London, UK and Ahmoud University, Borama, Somaliland. PARTICIPANTS: Final year medical students, newly graduated interns and second year interns at Ahmoud University, Borama, Somaliland. MAIN OUTCOME MEASURES: Qualitative and quantitative user rating of online case-based tutorials in the context of pre-existing educational opportunities available to them. RESULTS: Regular online teaching sessions are received enthusiastically by students and junior doctors and are reported to improve their clinical practice. CONCLUSIONS: Despite technological limitations in Somaliland, a live text-based teaching service can be delivered effectively and streamlined with local curricula. This represents an alternative to traditional static teaching methodologies currently used in international medical education.
Greaves F, Millett C, 2012, Consistently increasing numbers of online ratings of healthcare in England., J Med Internet Res, Vol: 14
Coltart CEM, Cheung R, Ardolino A, et al., 2012, Leadership development for early career doctors, LANCET, Vol: 379, Pages: 1847-1849, ISSN: 0140-6736
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- Citations: 19
Greaves F, Pape UJ, King D, et al., 2012, Associations Between Web-Based Patient Ratings and Objective Measures of Hospital Quality, ARCHIVES OF INTERNAL MEDICINE, Vol: 172, Pages: 435-436, ISSN: 0003-9926
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- Citations: 77
Noble D, Greaves F, Donaldson LJ, 2012, Patient safety., Understanding medical research: the studies that shaped medicine., Editors: Goodfellow, Goodfellow, London, Publisher: London: John Wiley and Sons, ISBN: 9781119963738
Chapter 2 Patient Safety Felix Greaves1, Douglas Noble2 and Sir Liam Donaldson3 1 Public Health Registrar and ... time we have begun to understand the frequency of medical error, we have moved forward in our understanding of why care is ...
Noble D, Greaves F, Donaldson LJ, 2012, Population Health., Understanding medical research: the studies that shaped medicine., Editors: Goodfellow, Goodfellow, London, Publisher: London: John Wiley and Sons, ISBN: 9781119963738
Chapter 1 Population Health Douglas Noble1, Felix Greaves2 and Sir Liam Donaldson3 1 Centre for Health Sciences, Barts and the London School of Medicine and Dentistry, London, UK 2 Department of Primary Care and Public Health, ...
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