Imperial College London

Dr Jonathan M Clarke

Faculty of Natural SciencesDepartment of Mathematics

Sir Henry Wellcome Postdoctoral Fellow
 
 
 
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Contact

 

j.clarke Website

 
 
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Location

 

St Marys Multiple BuildingsSt Mary's Campus

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Summary

 

Publications

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38 results found

Clarke J, Murray A, Markar S, Barahona M, Kinross Jet al., 2020, A new geographic model of care to manage the post-COVID-19 elective surgery aftershock in England: a retrospective observational study, BMJ Open, ISSN: 2044-6055

Objectives The suspension of elective surgery during the COVID pandemic is unprecedented and has resulted in record volumes of patients waiting for operations. Novel approaches that maximise capacity and efficiency of surgical care are urgently required. This study applies Markov Multiscale Community Detection (MMCD), an unsupervised graph-based clustering framework, to identify new surgical care models based on pooled waiting lists delivered across an expanded network of surgical providers. DesignRetrospective observational study using Hospital Episode Statistics.SettingPublic and private hospitals providing surgical care to National Health Service (NHS) patients in England. ParticipantsAll adult patients resident in England undergoing NHS-funded planned surgical procedures between 1st April 2017 and 31st March 2018. Main outcome measuresThe identification of the most common planned surgical procedures in England (High Volume Procedures – HVP) and proportion of low, medium and high-risk patients undergoing each HVP. The mapping of hospitals providing surgical care onto optimised groupings based on patient usage data.ResultsA total of 7,811,891 planned operations were identified in 4,284,925 adults during the one-year period of our study. The 28 most common surgical procedures accounted for a combined 3,907,474 operations (50.0% of the total). 2,412,613 (61.7%) of these most common procedures involved ‘low risk’ patients. Patients travelled an average of 11.3 km for these procedures. Based on the data, MMCD partitioned England into 45, 16 and 7 mutually exclusive and collectively exhaustive natural surgical communities of increasing coarseness. The coarser partitions into 16 and 7 surgical communities were shown to be associated with balanced supply and demand for surgical care within communities.ConclusionsPooled waiting lists for low risk elective procedures and patients across integrated, expanded natural surgical community networks have the pot

Journal article

Lam K, Clarke J, Purkayastha S, Kinross JMet al., 2020, Uptake and accessibility of surgical robotics in England, INTERNATIONAL JOURNAL OF MEDICAL ROBOTICS AND COMPUTER ASSISTED SURGERY, ISSN: 1478-5951

Journal article

Denning M, Goh ET, Scott A, Martin G, Markar S, Flott K, Mason S, Przybylowicz J, Almonte M, Clarke J, Winter Beatty J, Chidambaram S, Yalamanchili S, Yong-Qiang Tan B, Kanneganti A, Sounderajah V, Wells M, Purkayastha S, Kinross Jet al., 2020, What has been the impact of Covid-19 on Safety Culture? A case study from a large metropolitan teaching hospital, International Journal of Environmental Research and Public Health, Vol: 17, Pages: 1-14, ISSN: 1660-4601

Covid-19 has placed an unprecedented demand on healthcare systems worldwide. A positive safety culture is associated with improved patient safety and in turn patient outcomes. To date, no study has evaluated the impact of Covid-19 on safety culture. The Safety Attitudes Questionnaire (SAQ) was used to investigate safety culture at a large UK healthcare trust during Covid-19. Findings were compared with baseline data from 2017. Incident reporting from the year preceding the pandemic was also examined. SAQ scores of doctors and 'other clinical staff', were relatively higher than the nursing group. During Covid-19, on univariate regression analysis, female gender, age 40-49 years, non-white ethnicity, and nursing job role were all associated with lower SAQ scores. Training and support for redeployment were associated with higher SAQ scores. On multivariate analysis, non-disclosed gender (-0.13), non-disclosed ethnicity (-0.11), nursing role (-0.15), and support (0.29) persisted to significance. A significant decrease (p<0.003) was seen in error reporting after the onset of the Covid-19 pandemic. This is the first study to investigate SAQ during Covid-19. Differences in SAQ scores were observed during Covid-19 between professional groups when compared to baseline. Reductions in incident reporting were also seen. These changes may reflect perception of risk, changes in volume or nature of work. High-quality support for redeployed staff may be associated with improved safety perception during future pandemics.

Journal article

Beaney T, Clarke JM, Jain V, Golestaneh AK, Lyons G, Salman D, Majeed Aet al., 2020, Excess mortality: the gold standard in measuring the impact of COVID-19 worldwide?, Journal of the Royal Society of Medicine, Vol: 113, Pages: 329-334, ISSN: 0141-0768

Journal article

Markar SR, Clarke J, Kinross J, PanSurg Collaborative groupet al., 2020, Practice patterns of diagnostic upper gastrointestinal endoscopy during the initial COVID-19 outbreak in England., The Lancet Gastroenterology and Hepatology, Vol: 5, Pages: 804-805, ISSN: 2468-1253

Journal article

Markar SR, Martin G, Penna M, Yalamanchili S, Beatty JW, Clarke J, Erridge S, Sounderajah V, Denning M, Scott A, Purkayastha S, Kinross J, PanSurg Collaborative groupet al., 2020, Changing the paradigm of surgical research during a pandemic, Annals of Surgery, Vol: 272, Pages: e170-e171, ISSN: 0003-4932

The COVID-19 pandemic has led to a paradigm shift in how we manage surgical patients. Assuch, there is an immediate need to adapt the traditional model of surgical research in order tocreate pragmatic studies with adaptive designs in order to rapidly disseminate key knowledgeamongst the global surgical community.

Journal article

Clarke J, Beaney T, Majeed A, Darzi A, Barahona Met al., 2020, Identifying naturally occurring communities of primary care providers in the English National Health Service in London, BMJ Open, Vol: 10, Pages: 1-7, ISSN: 2044-6055

Objectives - Primary Care Networks (PCNs) are a new organisational hierarchy with wide-ranging responsibilities introduced in the National Health Service (NHS) Long Term Plan. The vision is that they represent ‘natural’ communities of general practices (GP practices) working together at scale and covering a geography that make sense to practices, other healthcare providers and local communities. Our study aims to identify natural communities of GP practices based on patient registration patterns using Markov Multiscale Community Detection, an unsupervised network-based clustering technique to create catchments for these communities.Design - Retrospective observational study using Hospital Episode Statistics – patient-level administrative records of inpatient, outpatient and emergency department attendances to hospital.Setting – General practices in the 32 Clinical Commissioning Groups of Greater London Participants - All adult patients resident in and registered to a GP practices in Greater London that had one or more outpatient encounters at NHS hospital trusts between 1st April 2017 and 31st March 2018.Main outcome measures The allocation of GP practices in Greater London to PCNs based on the registrations of patients resident in each Lower Super Output Area (LSOA) of Greater London. The population size and coverage of each proposed PCN. Results - 3,428,322 unique patients attended 1,334 GPs in 4,835 LSOAs in Greater London. Our model grouped 1,291 GPs (96.8%) and 4,721 LSOAs (97.6%), into 165 mutually exclusive PCNs. The median PCN list size was 53,490, with a lower quartile of 38,079 patients and an upper quartile of 72,982 patients. A median of 70.1% of patients attended a GP within their allocated PCN, ranging from 44.6% to 91.4%.Conclusions - With PCNs expected to take a role in population health management and with community providers expected to reconfigure around them, it is vital we recognise how PCNs represent their communities. O

Journal article

Denning M, Goh ET, Tan B, Kanneganti A, Almonte M, Scott A, Martin G, Clarke J, Sounderajah V, Markar S, Przybylowicz J, Chan YH, Sia C-H, Chua YX, Sim K, Lim L, Tan L, Tan M, Sharma V, Ooi S, Winter Beatty J, Flott K, Mason S, Chidambaram S, Yalamanchili S, Zbikowska G, Fedorowski J, Dykowska G, Wells M, Purkayastha S, Kinross Jet al., 2020, DETERMINANTS OF BURNOUT AND OTHER ASPECTS OF PSYCHOLOGICAL WELL-BEING IN HEALTHCARE WORKERS DURING THE COVID-19 PANDEMIC: A MULTINATIONAL CROSS-SECTIONAL STUDY

<jats:p>BackgroundThe Covid-19 pandemic has placed unprecedented pressure on healthcare systems and workers around the world. Such pressures may impact on working conditions, psychological wellbeing and perception of safety. In spite of this, no study has assessed the relationship between safety attitudes and psychological outcomes. Moreover, only limited studies have examined the relationship between personal characteristics and psychological outcomes during Covid-19.MethodsFrom 22nd March 2020 to 18th June 2020, healthcare workers from the United Kingdom, Poland, and Singapore were invited to participate using a self-administered questionnaire comprising the Safety Attitudes Questionnaire (SAQ), Oldenburg Burnout Inventory (OLBI) and Hospital Anxiety and Depression Scale (HADS) to evaluate safety culture, burnout and anxiety/depression. Multivariate logistic regression was used to determine predictors of burnout, anxiety and depression.ResultsOf 3,537 healthcare workers who participated in the study, 2,364 (67%) screened positive for burnout, 701 (20%) for anxiety, and 389 (11%) for depression. Significant predictors of burnout included patient-facing roles: doctor (OR 2.10; 95% CI 1.49-2.95), nurse (OR 1.38; 95% CI 1.04-1.84), and other clinical staff (OR 2.02; 95% CI 1.45-2.82); being redeployed (OR 1.27; 95% CI 1.02-1.58), bottom quartile SAQ score (OR 2.43; 95% CI 1.98-2.99), anxiety (OR 4.87; 95% CI 3.92-6.06) and depression (OR 4.06; 95% CI 3.04-5.42). Factors significantly protective for burnout included being tested for SARS-CoV-2 (OR 0.64; 95% CI 0.51-0.82) and top quartile SAQ score (OR 0.30; 95% CI 0.22-0.40). Significant factors associated with anxiety and depression, included burnout, gender, safety attitudes and job role.ConclusionOur findings demonstrate a significant burden of burnout, anxiety, and depression amongst healthcare workers. A strong association was seen between SARS-CoV-2 testing, safety attitudes, gender, job role, redeploymen

Journal article

Denning M, Goh ET, Scott A, Martin G, Markar S, Flott K, Mason S, Przybylowicz J, Almonte M, Clarke J, Winter-Beatty J, Chidambaram S, Yalamanchili S, Tan B, Kanneganti A, Sounderajah V, Wells M, Purkayastha S, Kinross Jet al., 2020, What has been the impact of Covid-19 on Safety Culture? A case study from a large metropolitan teaching hospital., Publisher: Cold Spring Harbor Laboratory

<jats:p>IntroductionCovid-19 has placed an unprecedented demand on healthcare systems worldwide. A positive safety culture is associated with improved patient safety and in turn patient outcomes. To date, no study has evaluated the impact of Covid-19 on safety culture. MethodsThe Safety Attitudes Questionnaire (SAQ) was used to investigate safety culture at a large UK teaching hospital during Covid-19. Findings were compared with baseline data from 2017. Incident reporting from the year preceding the pandemic was also examined. ResultsSignificant increased were seen in SAQ scores of doctors and 'other clinical staff', there was no change in the nursing group. During Covid-19, on univariate regression analysis, female gender, age 40-49 years, non-white ethnicity, and nursing job role were all associated with lower SAQ scores. Training and support for redeployment were associated with higher SAQ scores. On multivariate analysis, non-disclosed gender (-0.13), non-disclosed ethnicity (-0.11), nursing role (-0.15), and support (0.29) persisted to significance. A significant decrease (p&lt;0.003) was seen in error reporting after the onset of the Covid-19 pandemic. DiscussionThis is the first study to report SAQ during Covid-19 and compare with baseline. Differences in SAQ scores were observed during Covid-19 between professional groups and compared to baseline. Reductions in incident reporting were also seen. These changes may reflect perception of risk, changes in volume or nature of work. High-quality support for redeployed staff may be associated with improved safety perception during future pandemics.</jats:p>

Working paper

Beaney T, Clarke J, Barahona M, Majeed Aet al., 2020, A primary care network analysis: natural communities of general practices in London, Publisher: Royal College of General Practitioners, ISSN: 0960-1643

BACKGROUND: Primary care networks (PCNs) are a new organisational hierarchy introduced in the NHS Long Term Plan with wide-ranging responsibilities. The vision is that they represent 'natural' communities of general practices with boundaries that make sense to practices, other healthcare providers, and local communities. AIM: Our study aims to identify natural communities of general practices based on patient registration patterns, using network analysis methods and unsupervised clustering to create catchments for these communities. METHOD: Patients resident in and attending GP practices in London were identified from Hospital Episode Statistics from 2017 to 2018. We used a series of novel methods for unsupervised graph clustering. A cosine similarity matrix was constructed representing similarities between each general practice to each other, based on registration of patients in each Lower Super Output Area (LSOA). Unsupervised graph partitioning using Markov Multiscale Community Detection was conducted to identify communities of general practices. Catchments were assigned to each PCN based on the majority attendance from an LSOA. RESULTS: In total 3 428 322 unique patients attended 1334 GPs in general practices LSOAs in London. The model grouped 1291 general practices (96.8%) and 4721 LSOAs (97.6%), into 165 mutually exclusive PCNs. The median PCN list size was 53 490 and a median of 70.1% of patients attended a general practice within their allocated PCN, ranging from 44.6% to 91.4%. CONCLUSION: With PCNs expected to take a role in population health management and with community providers expected to reconfigure around them, it is vital we recognise how PCNs represent their communities. This method may be used by policymakers to understand the populations and geography shared between networks.

Conference paper

Appelbaum N, Rodriguez-Gonzalvez C, Clarke J, 2020, Ideal body weight in the precision era: recommendations for prescribing in obesity require thought for computer-assisted methods., Arch Dis Child, Vol: 105, Pages: 516-517

Journal article

Mason SE, Scott AJ, Markar SR, Clarke JM, Martin G, Winter Beatty J, Sounderajah V, Yalamanchili S, Denning M, Arulampalam T, Kinross JM, PanSurg Collaborativeet al., 2020, Insights from a global snapshot of the change in elective colorectal practice due to the COVID-19 pandemic., PLoS One, Vol: 15

BACKGROUND: There is a need to understand the impact of COVID-19 on colorectal cancer care globally and determine drivers of variation. OBJECTIVE: To evaluate COVID-19 impact on colorectal cancer services globally and identify predictors for behaviour change. DESIGN: An online survey of colorectal cancer service change globally in May and June 2020. PARTICIPANTS: Attending or consultant surgeons involved in the care of patients with colorectal cancer. MAIN OUTCOME MEASURES: Changes in the delivery of diagnostics (diagnostic endoscopy), imaging for staging, therapeutics and surgical technique in the management of colorectal cancer. Predictors of change included increased hospital bed stress, critical care bed stress, mortality and world region. RESULTS: 191 responses were included from surgeons in 159 centers across 46 countries, demonstrating widespread service reduction with global variation. Diagnostic endoscopy was reduced in 93% of responses, even with low hospital stress and mortality; whilst rising critical care bed stress triggered complete cessation (p = 0.02). Availability of CT and MRI fell by 40-41%, with MRI significantly reduced with high hospital stress. Neoadjuvant therapy use in rectal cancer changed in 48% of responses, where centers which had ceased surgery increased its use (62 vs 30%, p = 0.04) as did those with extended delays to surgery (p<0.001). High hospital and critical care bed stresses were associated with surgeons forming more stomas (p<0.04), using more experienced operators (p<0.003) and decreased laparoscopy use (critical care bed stress only, p<0.001). Patients were also more actively prioritized for resection, with increased importance of co-morbidities and ICU need. CONCLUSIONS: The COVID-19 pandemic was associated with severe restrictions in the availability of colorectal cancer services on a global scale, with significant variation in behaviours which cannot be fully accounted for by hospital burden or mortality.

Journal article

Warren L, Clarke J, Arora S, Darzi Aet al., 2019, Improving data sharing between acute hospitals in England: An overview of health record system distribution and retrospective observational analysis of inter-hospital transitions of care, BMJ Open, Vol: 9, ISSN: 2044-6055

ObjectivesTo determine the frequency of use and spatial distribution of health record systems in the English National Health Service (NHS). To quantify transitions of care between acute hospital trusts and health record systems to guide improvements to data sharing and interoperability.DesignRetrospective observational study using Hospital Episode Statistics.SettingAcute hospital trusts in the NHS in England.ParticipantsAll adult patients resident in England that had one or more inpatient, outpatient or accident and emergency encounters at acute NHS hospital trusts between April 2017 and April 2018.Primary and secondary outcome measuresFrequency of use and spatial distribution of health record systems. Frequency and spatial distribution of transitions of care between hospital trusts and health record systems.Results21,286,873 patients were involved in 121,351,837 encounters at 152 included trusts. 117 (77.0%) hospital trusts were using electronic health records (EHR). There was limited regional alignment of EHR systems. On 11,017,767 (9.1%) occasions, patients attended a hospital using a different health record system to their previous hospital attendance. 15,736,863 (73.9%) patients had two or more encounters with the included trusts and 3,931,255 (25.0%) of those attended two or more trusts. Over half (53.6%) of these patients had encounters shared between just 20 pairs of hospitals. Only two of these pairs of trusts used the same EHR system.ConclusionsEach year, millions of patients in England attend two or more different hospital trusts. Most of the pairs of trusts that commonly share patients do not use the same record systems. This research highlights significant barriers to inter-hospital data sharing and interoperability. Findings from this study can be used to improve electronic health record system coordination and develop targeted approaches to improve interoperability. The methods used in this study could be used in other healthcare systems that face the

Journal article

Feather C, Appelbaum N, Clarke J, Franklin B, Sinha R, Pratt P, Maconochie I, Darzi Aet al., 2019, Medication errors during simulated paediatric resuscitations: a prospective, observational human reliability analysis, BMJ Open, Vol: 9, Pages: 1-13, ISSN: 2044-6055

Introduction: Medication errors during paediatric resuscitation are thought to be common. However, there is little evidence about the individual process steps that contribute to such medication errors in this context.Objectives: To describe the incidence, nature and severity of medication errors in simulated paediatric resuscitations, and to employ human reliability analysis to understand the contribution of discrepancies in individual process steps to the occurrence of these errors.Methods: We conducted a prospective observational study of simulated resuscitations subjected to video micro-analysis, identification of medication errors, severity assessment and human reliability analysis in a large English teaching hospital. Fifteen resuscitation teams of two doctors and two nurses each conducted one of two simulated paediatric resuscitation scenarios. Results: At least one medication error was observed in every simulated case, and a large magnitude (>25% discrepant) or clinically significant error in 11 of 15 cases. Medication errors were observed in 29% of 180 simulated medication administrations, 40% of which considered to be moderate or severe. These errors were the result of 884 observed discrepancies at a number of steps in the drug ordering, preparation and administration stages of medication use, 8% of which made a major contribution to a resultant medication error. Most errors were introduced by discrepancies during drug preparation and administration. Conclusions: Medication errors were common with a considerable proportion likely to result in patient harm. There is an urgent need to optimise existing systems and to commission research into new approaches to increase the reliability of human interactions during administration of medication in the paediatric emergency setting.

Journal article

Appelbaum N, Rodriguez Gonzalvez C, Clarke J, 2019, Ideal bodyweight in the precision era: recommendations in obesity require thought for computer assisted prescribing, Archives of Disease in Childhood, ISSN: 0003-9888

As the prevalence of childhood obesity continues to increase, there has been comparatively slow growth in the literature describing how best to dose obese children. For medications with low lipid solubility where doses are calculated by the total body weight (TBW) of the child, increasing adiposity may lead to the administration of doses well in excess of that required for therapeutic effect, and potentially beyond the safe therapeutic interval of the medication. This concern underlies recommendations to use alternative bodyweight measurements for some medications when dosing obese children.

Journal article

Appelbaum N, Clarke J, Feather C, Franklin BD, Sinha R, Pratt P, Maconochie I, Darzi Aet al., 2019, Medication errors during simulated paediatric resuscitations: a prospective, observational human reliability analysis, Publisher: Cold Spring Harbor Laboratory

<jats:title>Abstract</jats:title><jats:sec><jats:title>Introduction</jats:title><jats:p>Medication errors during paediatric resuscitation are thought to be common. However, there is little evidence about the individual process steps that contribute to such medication errors in this context.</jats:p></jats:sec><jats:sec><jats:title>Objectives</jats:title><jats:p>To describe the incidence, nature and severity of medication errors in simulated paediatric resuscitations, and to employ human reliability analysis to understand the contributory role of individual process step discrepancies to these errors.</jats:p></jats:sec><jats:sec><jats:title>Methods</jats:title><jats:p>We conducted a prospective observational study of simulated resuscitations subject to video micro-analysis, identification of medication errors, severity assessment and human reliability analysis in a large English teaching hospital. Fifteen resuscitation teams of two doctors and two nurses each conducted one of two simulated paediatric resuscitation scenarios.</jats:p></jats:sec><jats:sec><jats:title>Results</jats:title><jats:p>At least one medication error was observed in every simulated case, and a large magnitude or clinically significant error in 11 of 15 cases. Medication errors were observed in 29% of 180 simulated medication administrations, 40% of which considered to be moderate or severe. These errors were the result of 884 observed discrepancies at a number of steps in the drug ordering, preparation and administration stages of medication use, 8% of which made a major contribution to a resultant medication error. Most errors were introduced by discrepancies during drug preparation and administration.</jats:p></jats:sec><jats:sec><jats:title>Conclusions</jats:title><jats:p>Medication errors were common with a conside

Working paper

Martin G, Clarke J, Liew F, Arora S, King D, Paul A, Darzi Aet al., 2019, Evaluating the impact of organisational digital maturity on clinical outcomes in secondary care in England, npj Digital Medicine, Vol: 2, ISSN: 2398-6352

All healthcare systems are increasingly reliant on health information technology to support the delivery of high-quality, efficient and safe care. Data on its effectiveness are however limited. We therefore sought to examine the impact of organisational digital maturity on clinical outcomes in secondary care within the English National Health Service. We conducted a retrospective analysis of routinely collected administrative data for 13,105,996 admissions across 136 hospitals in England from 2015 to 2016. Data from the 2016 NHS Clinical Digital Maturity Index were used to characterise organisational digital maturity. A multivariable regression model including 12 institutional covariates was utilised to examine the relationship between one measure of organisational digital maturity and five key clinical outcome measures. There was no significant relationship between organisational digital maturity and risk-adjusted 30-day mortality, 28-day readmission rates or complications of care. In multivariable analysis risk-adjusted long length of stay and harm-free care were significantly related to aspects of organisational digital maturity; digitally mature hospitals may not only deliver more harm-free care episodes but also may have a significantly increased risk of patients experiencing a long length of stay. Organisational digital maturity is to some extent related to selected clinical outcomes in secondary care in England. Digital maturity is, however, also strongly linked to other institutional factors that likely play a greater role in influencing clinical outcomes. There is a need to better understand how health IT impacts care delivery and supports other drivers of hospital quality.

Journal article

Warren L, Clarke J, Arora S, Barahona M, Arebi N, Darzi Aet al., 2019, Transitions of care across hospital settings in patients with inflammatory bowel disease, World Journal of Gastroenterology, Vol: 25, Pages: 2122-2132, ISSN: 1007-9327

BACKGROUNDInflammatory bowel disease (IBD) is a chronic, inflammatory disorder characterised by both intestinal and extra-intestinal pathology. Patients may receive both emergency and elective care from several providers, often in different hospital settings. Poorly managed transitions of care between providers can lead to inefficiencies in care and patient safety issues. To ensure that the sharing of patient information between providers is appropriate, timely, accurate and secure, effective data-sharing infrastructure needs to be developed. To optimise inter-hospital data-sharing for IBD patients, we need to better understand patterns of hospital encounters in this group.AIMTo determine the type and location of hospital services accessed by IBD patients in England.METHODSThis was a retrospective observational study using Hospital Episode Statistics, a large administrative patient data set from the National Health Service in England. Adult patients with a diagnosis of IBD following admission to hospital were followed over a 2-year period to determine the proportion of care accessed at the same hospital providing their outpatient IBD care, defined as their ‘home provider’. Secondary outcome measures included the geographic distribution of patient-sharing, regional and age-related differences in accessing services, and type and frequency of outpatient encounters.RESULTSOf 95055 patients accessed hospital services on 1760156 occasions over a 2-year follow-up period. The proportion of these encounters with their identified IBD ‘home provider’ was 73.3%, 87.8% and 83.1% for accident and emergency, inpatient and outpatient encounters respectively. Patients living in metropolitan centres and younger patients were less likely to attend their ‘home provider’ for hospital services. The most commonly attended specialty services were gastroenterology, general surgery and ophthalmology.CONCLUSIONTransitions of care between secondary care sett

Journal article

Clarke JM, Barahona M, Darzi AW, 2019, Defining Hospital Catchment Areas Using Multiscale Community Detection: A Case Study for Planned Orthopaedic Care in England

<jats:title>Abstract</jats:title><jats:sec><jats:title>Background</jats:title><jats:p>The English National Health Service 5-year Forward View emphasises the importance of integration of hospital and community services. Understanding the population a hospital serves is critical to formulating strategies for community engagement and determining their accountability for populations. Existing methods to define catchment areas are unable to adapt to dilute health care markets in urban areas where populations may interact with several different hospitals. Formulating catchment areas which permit the inclusion of more than one hospital based upon patient behaviour allows for collaboration between hospitals to reach out into the communities they collectively share.</jats:p></jats:sec><jats:sec><jats:title>Method</jats:title><jats:p>The proportion of presentations from all census Middle Super Output Areas (MSOAs) to every hospital trust providing orthopaedic care in England were calculated. The cosine similarity of all MSOAs to one another was computed from these proportions. Multiscale community detection was applied to planned orthopaedic surgical admissions in England from 1st April 2011 to 31st March 2015. Stable community configurations were identified and the proportion of patients presenting to hospitals located within the catchment area in which they resided was calculated. The performance of these catchment areas was compared to conventional methods for assigning mutually exclusive catchment areas.</jats:p></jats:sec><jats:sec><jats:title>Results</jats:title><jats:p>2,602,066 planned orthopaedic surgical admissions were identified for patients resident in 6,791 MSOAs in England attending 140 different hospital trusts. Markov multiscale community detection revealed five stable catchment area configurations consisting of 127, 51, 26, 15 and 11 catchment areas. B

Journal article

Moylan A, Appelbaum N, Clarke J, Feather C, Tairraz AF, Maconochie I, Darzi Aet al., 2019, Assessing the agreement of 5 ideal body weight calculations for selecting medication dosages for children with obesity, JAMA Pediatrics, ISSN: 2168-6203

Journal article

Clarke JM, Warren LR, Arora S, Barahona M, Darzi AWet al., 2018, Guiding interoperable electronic health records through patient-sharing networks, npj Digital Medicine, Vol: 1, Pages: 65-65, ISSN: 2398-6352

Effective sharing of clinical information between care providers is a critical component of a safe, efficient health system. National data-sharing systems may be costly, politically contentious and do not reflect local patterns of care delivery. This study examines hospital attendances in England from 2013 to 2015 to identify instances of patient sharing between hospitals. Of 19.6 million patients receiving care from 155 hospital care providers, 130 million presentations were identified. On 14.7 million occasions (12%), patients attended a different hospital to the one they attended on their previous interaction. A network of hospitals was constructed based on the frequency of patient sharing between hospitals which was partitioned using the Louvain algorithm into ten distinct data-sharing communities, improving the continuity of data sharing in such instances from 0 to 65–95%. Locally implemented data-sharing communities of hospitals may achieve effective accessibility of clinical information without a large-scale national interoperable information system.

Journal article

Arhi CS, Bottle A, Burns EM, Clarke JM, Aylin P, Ziprin P, Darzi Aet al., 2018, Comparison of cancer diagnosis recording between the Clinical Practice Research Datalink, Cancer Registry and Hospital Episodes Statistics, Cancer Epidemiology, Vol: 57, Pages: 148-157, ISSN: 0361-090X

IntroductionThe Clinical Practice Research Datalink (CPRD) is a large electronic dataset of primary care medical records. For the purpose of epidemiological studies, it is necessary to ensure accuracy and completeness of cancer diagnoses in CPRD.MethodCases included had a colorectal, oesophagogastric (OG), breast, prostate or lung cancer diagnosis recorded in a least one of CPRD, Cancer Registry (CR) or Hospital Episodes Statistics(HES) between 2000 and 2013. Agreement in diagnosis between the datasets, difference in dates, survival at one and five-years, and whether patient characteristics differed according to the dataset or the timing of diagnosis were investigated.Results116,769 patients were included. For each cancer, approximately 10% of cases identified from CPRD or HES were not confirmed in the CR. 25.5% colorectal, 26.0% OG, 8.9% breast, 32.0% lung and 18.6% prostate cases identified from the CR were missing in CPRD. The diagnosis date was recorded later in CPRD compared with CR for each cancer, ranging from 81.1% for prostate to 59.6% for colorectal, especially if the diagnosis was an emergency. Compared with the CR and HES, the adjusted risk of a missing diagnosis in CPRD was significantly higher if the patient was older, had more co-morbidities or was diagnosed as an emergency. Survival at one and five-years was highest for CPRD.ConclusionPatient demographics and the route of diagnosis impact the accuracy of cancer diagnosis in CPRD. Although CPRD provides invaluable primary care data, patients should ideally be identified from the CR to reduce bias.

Journal article

Modi N, Clarke J, McKee M, 2018, Health systems should be publicly funded and publicly provided., BMJ, Vol: 362, ISSN: 0959-8138

Journal article

Appelbaum N, Clarke J, Maconochie I, Darzi Aet al., 2017, A model for habitus-adjusted paediatric weight estimation by age and data concerning the validation of this method on a large dataset of English children., Data in Brief, Vol: 16, Pages: 771-774, ISSN: 2352-3409

It is often not possible to weigh children upon arrival at an emergency room before commencing the provision of emergency care. Because drugs for children are prescribed on the basis of age and body weight, estimations of weight are necessitated. Age-based equations have been one of the most commonly used weight estimation strategies historically. Due to the variability of weight for age in children, and variations in body habitus, these methods are inaccurate by design (Young and Korotzer, 2016) [1].

Journal article

Appelbaum N, Clarke J, Maconochie I, Darzi Aet al., 2017, Paediatric weight estimation by age in the digital era: optimising a necessary evil., Resuscitation, Vol: 122, Pages: 29-35, ISSN: 0300-9572

BACKGROUND: Age-based weight estimation methods are regularly used in paediatric emergency medicine despite their well-established inaccuracy. AIM: Determine the potential improvement in accuracy achievable by the use of a new mobile application, based on CDC/WHO weight-for-age centile data, which incorporates a gender assignment, a body habitus assessment, and which is capable of an age-in-months based calculation. METHODS: A theoretical, simulated validation study, comparing the performance of the widely used APLS/EPALS formulae against two contemporary habitus-adjusted methods, and the Helix Weight Estimation Tool. 1,070,743 children from the 2015/2016 UK National Child Measurement Program dataset, aged between 4 and 5 and 11 and 12 years, had age-based weight estimates made by all five methods. RESULTS: Primary outcomes were the percentage of weight estimations within 10%, 20%, and those greater than 20% discrepant from actual weight for each method. Our theoretical, gender-dependent, habitus-adjusted method performed better than all other methods across all error thresholds. The overall number of estimations within 10% was 70.4%, and within 20% was 95.45%. The mean percentage error was -1% compared to actual weight. CONCLUSION: The use of a digital tool incorporating a subjective assessment of body habitus, gender assignment, and the ability to estimate weight based on age-in-months might be able optimise the process of paediatric weight estimation by age, making this practice as safe and accurate as possible for the occasions when weight estimation by age is chosen over length-based methods.

Journal article

Clarke JM, 2016, Stop denying migrants their fundamental right to healthcare, BMJ, Pages: i1971-i1971

Journal article

Strong S, Blencowe N, Bhangu A, 2015, How good are surgeons at identifying appendicitis? Results from a multi-centre cohort study, INTERNATIONAL JOURNAL OF SURGERY, Vol: 15, Pages: 107-112, ISSN: 1743-9191

Journal article

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