Publications
151 results found
Macinko J, Harris MJ, 2015, Brazil's Family Health Strategy REPLY, NEW ENGLAND JOURNAL OF MEDICINE, Vol: 373, Pages: 1278-1278, ISSN: 0028-4793
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- Citations: 8
Cowling TE, Harris M, Watt H, et al., 2015, Access to primary care and the route of emergency admission to hospital: retrospective analysis of national hospital administrative data, BMJ Quality & Safety, Vol: 25, Pages: 432-440, ISSN: 2044-5415
Background The UK government is pursuing policies to improve primary care access, as many patients visit accident and emergency (A and E) departments after being unable to get suitable general practice appointments. Direct admission to hospital via a general practitioner (GP) averts A and E use, and may reduce total hospital costs. It could also enhance the continuity of information between GPs and hospital doctors, possibly improving healthcare outcomes.Objective To determine whether primary care access is associated with the route of emergency admission—via a GP versus via an A and E department.Methods Retrospective analysis of national administrative data from English hospitals for 2011–2012. Adults admitted in an emergency (unscheduled) for ≥1 night via a GP or an A and E department formed the study population. The measure of primary care access—the percentage of patients able to get a general practice appointment on their last attempt—was derived from a large, nationally representative patient survey. Multilevel logistic regression was used to estimate associations, adjusting for patient and admission characteristics.Results The analysis included 2 322 112 emergency admissions (81.9% via an A and E department). With a 5 unit increase in the percentage of patients able to get a general practice appointment on their last attempt, the adjusted odds of GP admission (vs A and E admission) was estimated to increase by 15% (OR 1.15, 95% CI 1.12 to 1.17). The probability of GP admission if ≥95% of appointment attempts were successful in each general practice was estimated to be 19.6%. This probability reduced to 13.6% when <80% of appointment attempts were successful. This equates to 139 673 fewer GP admissions (456 232 vs 316 559) assuming no change in the total number of admissions. Associations were consistent in direction across geographical regions of England.Conclusions Among hospital inpatients admitted as an emergency, patients
Harris M, Burgess CP, Kringos DS, 2015, Hope for US health care despite strong headwinds, BRITISH JOURNAL OF GENERAL PRACTICE, Vol: 65, Pages: 367-367, ISSN: 0960-1643
Macinko J, Harris MJ, 2015, INTERNATIONAL HEALTH CARE SYSTEMS Brazil's Family Health Strategy - Delivering Community-Based Primary Care in a Universal Health System, New England Journal of Medicine, Vol: 372, Pages: 2177-2181, ISSN: 1533-4406
Harris MJ, Dadwal V, Wu A, et al., 2015, It takes threat of Ebola to see lessons from low income countries, Globalization and Health, Vol: 11, ISSN: 1744-8603
Piterman L, Harris M, Saddi FC, et al., 2015, International primary care snapshots: Australia and Brazil, BRITISH JOURNAL OF GENERAL PRACTICE, Vol: 65, Pages: 198-199, ISSN: 0960-1643
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- Citations: 2
Cowling TE, Harris MJ, Majeed A, 2015, Evidence and rhetoric about access to UK primary care, British Medical Journal, Vol: 350, Pages: h1513-h1513, ISSN: 1468-5833
Watt H, Harris M, Noyes J, et al., 2015, Development of a composite outcome score for a complex intervention - measuring the impact of Community Health Workers, Trials, Vol: 16, ISSN: 1745-6215
BackgroundIn health services research, composite scores to measure changes in health-seeking behaviour and uptake of services do not exist. We describe the rationale and analytical considerations for a composite primary outcome for primary care research. We simulate its use in a large hypothetical population and use it to calculate sample sizes. We apply it within the context of a proposed cluster randomised controlled trial (RCT) of a Community Health Worker (CHW) intervention.MethodsWe define the outcome as the proportion of the services (immunizations, screening tests, stop-smoking clinics) received by household members, of those that they were eligible to receive. First, we simulated a population household structure (by age and sex), based on household composition data from the 2011 England and Wales census. The ratio of eligible to received services was calculated for each simulated household based on published eligibility criteria and service uptake rates, and was used to calculate sample size scenarios for a cluster RCT of a CHW intervention. We assume varying intervention percentage effects and varying levels of clustering.ResultsAssuming no disease risk factor clustering at the household level, 11.7% of households in the hypothetical population of 20,000 households were eligible for no services, 26.4% for 1, 20.7% for 2, 15.3% for 3 and 25.8% for 4 or more. To demonstrate a small CHW intervention percentage effect (10% improvement in uptake of services out of those who would not otherwise have taken them up, and additionally assuming intra-class correlation of 0.01 between households served by different CHWs), around 4,000 households would be needed in each of the intervention and control arms. This equates to 40 CHWs (each servicing 100 households) needed in the intervention arm. If the CHWs were more effective (20%), then only 170 households would be needed in each of the intervention and control arms.ConclusionsThis is a useful first step towards a proce
Cowling TE, Harris MJ, Majeed A, 2015, Access to Primary Care in England, JAMA INTERNAL MEDICINE, Vol: 175, Pages: 467-467, ISSN: 2168-6106
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- Citations: 2
Ignatowicz A, Greenfield G, Pappas Y, et al., 2014, Achieving Provider Engagement: Providers' Perceptions of Implementing and Delivering Integrated Care, Qualitative Health Research, Vol: 24, Pages: 1711-1720, ISSN: 1552-7557
The literature on integrated care is limited with respect to practical learning and experience. Although some attention has been paid to organizational processes and structures, not enough is paid to people, relationships, and the importance of these in bringing about integration. Little is known, for example, about provider engagement in the organizational change process, how to obtain and maintain it, and how it is demonstrated in the delivery of integrated care. Based on qualitative data from the evaluation of a large-scale integrated care initiative in London, United Kingdom, we explored the role of provider engagement in effective integration of services. Using thematic analysis, we identified an evolving engagement narrative with three distinct phases: enthusiasm, antipathy, and ambivalence, and argue that health care managers need to be aware of the impact of professional engagement to succeed in advancing the integrated care agenda.
Greenfield G, Ignatowicz AM, Belsi A, et al., 2014, Wake up, wake up! It's me! It's my life! patient narratives on person-centeredness in the integrated care context: a qualitative study., BMC Health Services Research, Vol: 14, ISSN: 1472-6963
BackgroundPerson-centered care emphasizes a holistic, humanistic approach that puts patients first, at the center of medical care. Person-centeredness is also considered a core element of integrated care. Yet typologies of integrated care mainly describe how patients fit within integrated services, rather than how services fit into the patient¿s world. Patient-centeredness has been commonly defined through physician¿s behaviors aimed at delivering patient-centered care. Yet, it is unclear how `person-centeredness¿ is realized in integrated care through the patient voice. We aimed to explore patient narratives of person-centeredness in the integrated care context.MethodsWe conducted a phenomenological, qualitative study, including semi-structured interviews with 22 patients registered in the Northwest London Integrated Care Pilot. We incorporated Grounded Theory approach principles, including substantive open and selective coding, development of concepts and categories, and constant comparison.ResultsWe identified six themes representing core `ingredients¿ of person-centeredness in the integrated care context: ¿Holism¿, ¿Naming¿, ¿Heed¿, ¿Compassion¿, ¿Continuity of care¿, and ¿Agency and Empowerment¿, all depicting patient expectations and assumptions on doctor and patient roles in integrated care. We bring examples showing that when these needs are met, patient experience of care is at its best. Yet many patients felt `unseen¿ by their providers and the healthcare system. We describe how these six themes can portray a continuum between having own physical and emotional `Space¿ to be `seen¿ and heard vs. feeling `translucent¿, `unseen¿, and unheard. These two conflicting experiences raise questions about current typologies of the patient-physician relationship as a `dyad¿, the meanings patients attributed to `care&
Harris M, 2014, Research papers should omit their authors' affiliations, BMJ-BRITISH MEDICAL JOURNAL, Vol: 349, ISSN: 1756-1833
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- Citations: 2
Saddi FC, Harris M, Pego RA, et al., 2014, Elections could rekindle health debate in Brazil., Lancet, Vol: 384, Pages: e47-e48, ISSN: 1474-547X
Harris MJ, 2014, We could all learn from Brazil's Family Health Program., BMJ, Vol: 349
Harris MJ, 2014, PRIMARY HEALTHCARE AND MORTALITY We could all learn from Brazil's Family Health Program, BMJ-BRITISH MEDICAL JOURNAL, Vol: 349, ISSN: 0959-535X
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- Citations: 1
Cowling TE, Harris MJ, Watt HC, et al., 2014, Access to general practice and visits to accident and emergency departments in England: cross-sectional analysis of a national patient survey, British Journal of General Practice, Vol: 64, Pages: e434-e439, ISSN: 1478-5242
Mastellos N, Gunn L, Harris M, et al., 2014, Assessing patients' experience of integrated care: a survey of patient views in the North West London Integrated Care Pilot., International Journal of Integrated Care, Vol: 14, ISSN: 1568-4156
INTRODUCTION: Despite the importance of continuity of care and patient engagement, few studies have captured patients' views on integrated care. This study assesses patient experience in the Integrated Care Pilot in North West London with the aim to help clinicians and policymakers understand patients' acceptability of integrated care and design future initiatives.METHODS: A survey was developed, validated and distributed to 2029 randomly selected practice patients identified as having a care plan.RESULTS: A total of 405 questionnaires were included for analysis. Respondents identified a number of benefits associated with the pilot, including increased patient involvement in decision-making, improved patient-provider relationship, better organisation and access to care, and enhanced inter-professional communication. However, only 22.4% were aware of having a care plan, and of these only 37.9% had a copy of the care plan. Knowledge of care plans was significantly associated with a more positive experience.CONCLUSIONS: This study reinforces the view that integrated care can improve quality of care and patient experience. However, care planning was a complex and technically challenging process that occurred more slowly than planned with wide variation in quality and time of recruitment to the pilot, making it difficult to assess the sustainability of benefits.
Vamos EP, Pape UJ, Curcin V, et al., 2014, Influenza vaccine effectiveness against hospitalisation and death in people with Type 2 diabetes, Publisher: WILEY-BLACKWELL, Pages: 74-75, ISSN: 0742-3071
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- Citations: 1
Dalton A, Vamos E, Harris M, et al., 2014, Impact of universal coverage on hypertension management: a cross-national study in the United States and England, PLoS ONE, Vol: 9, ISSN: 1932-6203
Background: The Patient Protection and Affordable Care Act (ACA) galvanised debate in the United States (US) overuniversal health coverage. Comparison with countries providing universal coverage may illustrate whether the ACA canimprove health outcomes and reduce disparities. We aimed to compare quality and disparities in hypertensionmanagement by socio-economic position in the US and England, the latter of which has universal health care.Method: We used data from the Health and Retirement Survey in the US, and the English Longitudinal Study for Aging fromEngland, including non-Hispanic White respondents aged 50–64 years (US market-based v NHS) and .65 years (USMedicarev NHS) with diagnosed hypertension. We compared blood pressure control to clinical guideline (140/90 mmHg)and audit (150/90 mmHg) targets; mean systolic and diastolic blood pressure and antihypertensive prescribing, anddisparities in each by educational attainment, income and wealth, using regression models.Results: There were no significant differences in aggregate achievement of clinical targets aged 50 to 65 years (US marketbasedvs. NHS- 62.3% vs. 61.3% [p = 0.835]). There was, however, greater control in the US in patients aged 65 years and over(US Medicare vs. NHS- 53.5% vs. 58.2% [p = 0.043]). England had no significant socioeconomic disparity in blood pressurecontrol (60.9% vs. 63.5% [p = 0.588], high and low wealth aged $65 years). The US had socioeconomic differences in the 50–64 years group (71.7% vs. 55.2% [p = 0.003], high and low wealth); these were attenuated but not abolished in Medicarebeneficiaries.Conclusion: Moves towards universal health coverage in the US may reduce disparities in hypertension management. Thecurrent situation, providing universal coverage for residents aged 65 years and over, may not be sufficient for equality incare.
Greenfield G, Ignatowicz AM, Majeed A, et al., 2014, Patient narratives on person-centeredness in the integrated care context, INTERNATIONAL JOURNAL OF INTEGRATED CARE, Vol: 14, ISSN: 1568-4156
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- Citations: 1
Cowling TE, Harris MJ, Soljak MA, et al., 2013, Opening hours of general practices in England, British Medical Journal, Vol: 347
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
Harris M, 2013, Community health workers: an opportunity for reverse innovation, LANCET, Vol: 382, Pages: 1326-1327, ISSN: 0140-6736
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- Citations: 8
Cowling TE, Harris MJ, Majeed A, 2013, What Is Our Plan for Acute Unscheduled Care?, Annals of Internal Medicine, Vol: 159, Pages: 575-576
Mandeville K, Harris M, Thomas L, et al., 2013, Using social networking sites for communicable disease control: innovative contact tracing or breach of confidentiality?, Public Health Ethics, Vol: 7, Pages: 47-50, ISSN: 1754-9981
Social media applications such as Twitter, YouTube and Facebook have attained huge popularity, with more than three billion people and organizations predicted to have a social networking account by 2015. Social media offers a rapid avenue of communication with the public and has potential benefits for communicable disease control and surveillance. However, its application in everyday public health practice raises a number of important issues around confidentiality and autonomy. We report here a case from local level health protection where the friend of an individual with meningococcal septicaemia used a social networking site to notify potential contacts.
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
Cowling T, Soljak M, Cecil E, et al., 2013, Access to primary care and visits to emergency departments in England: a cross-sectional, population-based study, PLoS One, Vol: 8, ISSN: 1932-6203
BackgroundThe number of visits to hospital emergency departments (EDs) in England has increased by 20% since 2007-08, placing unsustainable pressure on the National Health Service (NHS). Some patients attend EDs because they are unable to access primary care services. This study examined the association between access to primary care and ED visits in England.MethodsA cross-sectional, population-based analysis of patients registered with 7,856 general practices in England was conducted, for the time period April 2010 to March 2011. The outcome measure was the number of self-referred discharged ED visits by the registered population of a general practice. The predictor variables were measures of patient-reported access to general practice services; these were entered into a negative binomial regression model with variables to control for the characteristics of patient populations, supply of general practitioners and travel times to health services.Main Result and ConclusionGeneral practices providing more timely access to primary care had fewer self-referred discharged ED visits per registered patient (for the most accessible quintile of practices, RR = 0.898; P<0.001). Policy makers should consider improving timely access to primary care when developing plans to reduce ED utilisation.
Johnson CD, Noyes J, Haines A, et al., 2013, Learning from the Brazilian community health worker model in North Wales, Globalization and Health, Vol: 9, ISSN: 1744-8603
Health policymakers in many countries are looking at ways of increasing health care coverage by scaling up the deployment of community health workers. In this commentary, we describe the rationale for the UK to learn from Brazil’s scaled-up Community Health Worker primary care strategy, starting with a pilot project in North Wales.
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.
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.
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