NIHRDataInsights/HRCSData huggingface dataset:
Title: Patient Level Information and Costing Systems (PLICS): Current practice and future potential for the NHS health economy
Funder: Department of Health (England)

Abstract: Research designHealthcare is a complex open system. Therefore closed condition controlled experimental approaches cannot be adopted. However ‘natural’ experiments do arise in open systems For example CIMA (2008) identified three main uses for PLICS in the acute sector: (i) cost improvement in the context of financial challenge (ii) to underpin a case for investment or reconfiguration of services or (iii) as a better management tool. The research will capture these different approaches (or naturally occurring experiments in PLICS use) though employing a mixed methods design (Bryman 2006; Creswell2003; Tashakkori & Teddie 2003). The specific method will be ‘sequential explanatory design’ employing quantitative data collection and analysis before qualitative (Cresswell 2003:209) This design enables the qualitative stage to be informed by the quantitative analysis. Research methodsWorkpackage 1 will survey (a) the 95 acute Trusts and the 12 other organizations (mostly mental health) that the Department of Health identified as using or in the process of implementing PLICS (b) Commissioners (one from each of the new 52 PCT cluster groups and all of the pathfinder GP consortia or new clinician commissioning groups). Workpackage 1 will comprise 3 stages: (1) Pilot study (2) Main study (3) Follow up telephone interviews to aid indentification of case study sites. Workpackage 1 is the primary means to answer research question : How are NHS Trusts and commissioners using PLICS?Workpackage 2Drawing on data from Workpackage 1 Workpackage 2 will further analyse the potential of PLICS in relation to our key aims: cost improvement; better allocative efficiency and congruence with patient preferences; understanding clinical variation in resource use; the relationships between cost and quality; and greater clinical engagement. We will conduct 4 case studies. At each case site we will engage with and report on PLICS systems conduct semi-structured interviews and documentary analysis. All key informants (FDs cost accountants service line managers and clinicians) on PLICS at each site will be invited for interview. We anticipate interviewing ten informants at each (totalling forty in all). We expect there will be varying progress with PLICS in different conditions. We will use 6 tracer conditions to capture this variability. Workpackage 2 is the primary means to answering research question 2: How can PLICS be used to benefit the total health economy (cost improvement resource allocation across services and settings linking costs with quality and clinical engagement)?More detail on design methods data collection and data analysis is available on the detailed project description.


Research activity codes: 8.2 HEALTH AND WELFARE ECONOMICS;8.3 POLICY, ETHICS AND RESEARCH GOVERNANCE
Health categories: GENERIC HEALTH RELEVANCE
Title: How can international evidence on interventions to manage referral from primary to specialist non-emergency care be applied in a UK context? Development of an inclusive systematic review and logic model
Funder: Department of Health (England)

Abstract: We plan to use an innovative method which combines systematic review and logic modelling techniques to develop an evidence-based framework to define links between interventions and health outcomes. The evidence synthesis and accompanying logic model will provide a strategic perspective on the understanding of how international referral management interventions may be applied in the UK context. It will uncover and evaluate assumptions underpinning how interventions may lead to enhanced outcomes and provide a framework for communication and discussion. The work will thus be directly relevant for informing NHS managers and other stakeholders and for developing practice. The synthesis will also provide an overview of the current state of knowledge in the field and indicate where further research is needed. By examining links between interventions and outcomes it will provide valuable insights into the outcome measures currently in use and have the potential to inform the future measurement of effectiveness. The core research team have worked together for over three years as part of the NICE Public Health Collaborating Centre conducting systematic reviews of effectiveness and cost effectiveness of complex interventions on a number of policy directed topics as well as developing innovative methodologies in evidence synthesis. The successful processes of working developed during this time have created a coherent and efficient team capable of undertaking this proposed research. In addition Andrew Lee Nick Payne and Martin McShane bring further considerable NHS practice commissioning and management knowledge whilst Danuta Kasprzyk and Helena Britt provide international collaboration allowing the team to draw on their knowledge and advice at every stage of the project from bid submission to dissemination.


Research activity codes: 8.4 RESEARCH DESIGN AND METHODOLOGIES (HEALTH SERVICES)
Health categories: GENERIC HEALTH RELEVANCE
Title: Better guidelines for better care: accounting for multimorbidity in clinical guidelines
Funder: Chief Scientist Office (Scotland)

Abstract: Clinical guidelines do not currently account for multimorbidity even though the majority of people with any chronic condition have more than one such condition. The aim of this research is to test the methodological feasibility of new approaches to summarising and creating evidence for guidelines for the management of people with multimorbidity. The study will focus on three common and important conditions and will use a Guidelines Development Group (GDG) convened by NICE to recommend the focus of activity for both objectives to inform methodological development and help judge usefulness and feasibility. Objective 1 methods (months 1-18: to systematically collate and summarise the evidence of benefit & cost effectiveness for guideline recommendations). Both the pharmacist and economist employed researchers will work together to (a) cross-reference guideline recommended treatments for synergy and contradiction with each other and with other commonly prescribed treatment; (b) summarise existing estimates of benefit harm and cost effectiveness; (c) systematically record the strength and generalisability of evidence including its applicability to real-world populations especially those with multimorbidity; and (d) combine collated data to allow comparison of recommendations from different guidelines. Objective 2 methods (months 7-30: to develop & evaluate exploratory modelling methods to compare multiple disease-based guideline recommendations; led by the economist supported by the pharmacist). Existing NICE economic models for a small number of guideline recommended treatments will be adapted to model benefits and costs of treatment for people with multimorbidity. Since high quality data will often not be available required adaptations to models will be identified using Classical Delphi consensus methods systematic literature review and structured expert elicitation using mathematical aggregation methods. Analysis will use existing NICE best practice for economic modelling including extensive sensitivity analysis and will additionally examine the feasibility and applicability of proposed ‘pay-off’ time approaches. Study findings will both inform future research and be of relevance to future guideline design and implementation.


Research activity codes: 7.3 MANAGEMENT AND DECISION MAKING;8.2 HEALTH AND WELFARE ECONOMICS
Health categories: GENERIC HEALTH RELEVANCE
Title: Mobilising knowledge to improve UK health care: learning from other countries and other sectors
Funder: Chief Scientist Office (Scotland)

Abstract: Achieving a healthcare system of the highest quality depends on making the most effective use of research-based knowledge. Traditional models of ‘knowledge transfer’ are not sufficient and more sophisticated strategies of ‘knowledge mobilisation’ have to be developed. However understanding of ‘knowledge mobilisation’ is still in its infancy. Although the past decade has seen a plethora of practical activity by research funders and research intermediaries aimed at securing better research engagement relatively little is known about the thinking underpinning these initiatives their practical challenges or the factors facilitating their success. This 18 month project seeks to learn from experience of knowledge mobilisation to better inform such work in the NHS for the long-term improvement of NHS services and better patient care. Two main areas of experience will be exploited: first international experience of knowledge mobilisation strategies used for health-related research; and second UK experience of knowledge mobilisation strategies used for both health research and research in two key related areas (social care and education). Using a combination of desk research (predominantly months 1-12) interviews (months 4-12) a web-based survey (months 13-15) and interactive workshops with key stakeholders in NHS research (month 6 and month 16) we will address three objectives with associated research questions: 1. Mapping the knowledge mobilisation landscape: a) What knowledge mobilisation strategies have been developed in health care (in the UK and internationally) to better promote the uptake and use of research? b) What analogous knowledge mobilisation strategies have been developed in social care and education within the UK? 2. Understanding the models theories and frameworks that underpin approaches to knowledge mobilisation:a) What models theories or frameworks have been used explicitly – or can be discerned as implicit underpinning logics – in the development of the knowledge mobilisation strategies reviewed? b) What evidence is available from existing reviews and secondary sources on the mechanisms of action of these models theories and frameworks?3. Learning from the success or otherwise of these enacted strategies:a) What evaluative data are available on the success or otherwise of these enacted strategies and what do these data suggest are the most promising approaches to successful knowledge mobilisation? b) What formative learning has accumulated through the practical experience of the programmes as implemented?


Research activity codes: 8.3 POLICY, ETHICS AND RESEARCH GOVERNANCE
Health categories: GENERIC HEALTH RELEVANCE
Title: Developing indicators of change in NHS equity performance
Funder: Department of Health (England)

Abstract: This project aims to develop useful indicators of change in NHS equity performance based on time series change in socioeconomic gradients in health care utilisation and outcomes. This research is needed because NHS decision makers have a duty to have regard to the need to reduce inequalities in outcomes and access to services but do not have any routine equity performance indicators that enable them to discharge this duty effectively. Simple disaggregation of the performance indicators in the NHS Outcomes Framework will not suffice since this will not tell decision makers how far the NHS is responsible for cross sectional variation in utilisation and outcomes. We will select a manageable number of indicators following investigation of technical feasibility and a stakeholder consultation process. General indicators - for example all non-emergency hospital admissions and mortality from causes considered amenable to health care - will be supplemented with groups of specific indicators relating to a small number of specific disease areas. Indicators will include both patient level and small area level indicators and indicators using both primary and secondary care data. Each indicator will be constructed using comprehensive national data disaggregated to measure patient level or small area level socioeconomic inequality using both absolute and relative inequality measures and tracked over time to examine time series change in social gradients from 2001/2 to 2014/15. We will allow for observable change in non-NHS determinants of inequality in both small area level and patient level analyses - in area level analyses using data on small area population need (e.g. ONS data on demographic and ethnic mix and QOF data on disease prevalence smoking and obesity) and in patient level analysis using data on patient risk factors (e.g. HES data on age sex ethnicity and diagnoses). We will then attempt to identify NHS determinants of change in social gradients on the plausible assumption that changes in NHS delivery can have short run effects on social gradients in health care utilisation and outcomes over a period of a few years whereas many wider non-NHS determinants of social gradients change slowly or have long delayed effects over decades rather than years. We will identify NHS effects by first consulting specialist clinicians to identify plausible NHS determinants of change for particular indicators and then (a) comparing patterns of change between different indicators at different points on the patient pathway and (b) using quasi-experimental research designs such as interrupted time series and difference-in-difference studies. We will present our findings to local and national NHS decision makers in the form of equity dashboards that help to pinpoint change in social inequalities in health care utilisation and outcomes in different geographical areas disease areas and points on the patient pathway.


Research activity codes: 8.5 RESOURCES AND INFRASTRUCTURE (HEALTH SERVICES)
Health categories: GENERIC HEALTH RELEVANCE
Title: Comprehensive Longitudinal Assessment of Salford Integrated Care (CLASSIC): a study of the implementation and effectiveness of a new model of care for long-term conditions
Funder: Department of Health (England)

Abstract: The Salford Integrated Care Programme (SICP) is a project to transform care for older people with long-term conditions and social care needs.The SICP will improve care via: • Enhanced self management through improved access to community resources and support.• Introduction of multidisciplinary health and social care groups to improve integration• Access to an integrated contact centre to support navigation and self managementCLASSIC is designed to evaluate the ability of the SICP to deliver improvements in experience health outcomes and cost effectiveness in older patients. DesignWe will adopt a cohort multiple randomised controlled trial. A large population cohort will be recruited and followed over time with subgroups within the cohort used to evaluate different interventions (Relton 2013).CLASSIC will recruit a cohort of older people with long term conditions (N=4000) in Salford sampling patients with varying number of conditions and associated social care needs.Participants will be followed up every 6 months with measures of service experience health and care utilisation linked to Salford Integrated Record data on clinical parameters and care utilisation. We will also conduct in depth qualitative work in the cohort to support research themes (see below). Cohort members will provide consent to be contacted about substudies nested within the CLASSIC cohort facilitating proactive recruitment of older people. Evaluation in the cohortThere are 4 four types of evaluation in CLASSICPopulation level: The cohort will allow assessment of the effect of the SICP on overallpopulation experience health and costs over time with repeated measurements allowing rigorous time series analysis (Campbell 2009)Cluster level: Individuals in the cohort will be clustered by local groups of practices. Aspects of the SICP will be tested in a ‘staged’ manner introducing change in some areas before others allowing evaluation through comparison of clusters receiving early and late implementation. Individual-level: Within clusters we will allocate individuals to certain SICP components such as health coaching’ (i.e. proactive telephone self management support) via the ‘integrated contact centre’External comparators: There will be comparisons with sites outside Salford using routinely available data on service experience utilisation and mortality with appropriate non-experimental methods (Sutton 2012).In the initial phase we will undertake 4 studies 2 on implementation and 2 on outcomes. If the initial phase is successful bids for further funding to NIHR HS&DR and other funders may be made to undertake more detailed assessments of other aspects of the programme (such as the community assets and the introduction of economic incentives with SICP) and to assess outcomes in the longer term.


Research activity codes: 7.1 INDIVIDUAL CARE NEEDS;7.3 MANAGEMENT AND DECISION MAKING
Health categories: GENERIC HEALTH RELEVANCE
Title: A comprehensive profile and comparative analysis of the characteristics patient experience and community value of the ‘classic’ community hospital situated in contrasting contexts and communities
Funder: Department of Health (England)

Abstract: The primary aim is to provide a comprehensive profile and comparative analysis of the characteristics patient experience and community value of the classic community hospital (CH) in contrasting local contexts and in relationship with local communities. There are three core research questions. 1. What is a community hospital? 2. What are patients’ experiences of community hospital care and services?3. What does the community do for its community hospital and what does the community hospital do for its community?Research design and data collection: There are a number of inter-dependent elements conducted by us as well as two other reserch teams(Nolte and Young). For the purposes of this application only those elements we are involved in undertaking are discussed in detail: 1) A mapping exercise reconciling major datasets; classifying CHs; and administering a resource data survey (survey has been developed with the Young team and follow-up support for completion undertaken by us).2) Through nine comparative case studies sites examining: patient experience and community valueAnalysis:- Mapping CH data will follow the Nolte literature review plus location and provide a typology - Mapping resources data will be analysed to produce a standardised data set of (a) equity of provision (b) service utilisation (c) productivity for CHs across the UK.- Interviews and focus groups will be transcribed and qualitative coding software used to facilitate data storage and retrieval. Analysis will involve a range of conceptual frameworks depending on the research element. External validity and transferability of analysis will be addressed through detailed description and data-triangulation between work-packages.Research outputs:- Plain language executive summary for community stakeholders involved in the study- A UK wide map and comprehensive database of community hospitals- Production of a final report to HS&DR specifications suitable for peer review- Short document for each case study site detailing key findings on patient experience and community value and the place of CHs in the local health and social care context and community and implications for commissioning. Benefits and impact: - Add to knowledge of local communities CHs commissioners and other providers- Demonstrate impact of CH services on individual patients CH initiatives on the community - Support decision makers to take a whole system approach by demonstrating inter-dependencies of local health and social care services and the current and potential role of CH within the broader architecture of the NHS.


Research activity codes: 8.1 ORGANISATION AND DELIVERY OF SERVICES
Health categories: GENERIC HEALTH RELEVANCE
Title: Do Not Attempt Cardiopulmonary Resusitation (DNACPR) Decisions: Evidence Synthesis
Funder: Department of Health (England)

Abstract: This study will summarise the research evidence around Do Not Attempt Cardiopulmonary Resuscitatio (DNACPR) decisions explore the reasons why conflict and complaints arise and identify inconsistencies in implementation of national guidelines across the NHS and examples of best practice.We will establish and engage a stakeholder group at the start of the project. The stakeholder group under the guidance of a lay chair (co-applicant Barry Williams) will include healthcare users their relatives healthcare providers ethicists legal personnel and policy makers. This group will ensure the research remains focused on the issues that are important to patients and their families relevant to NHS practice and compliant with ethical and regulatory / legal frameworks.The programme of work will be divided into 5 discrete work packages (see project flow diagram). In brief:Work package (WP) 1 will synthesise existing research evidence for DNACPR decisions through a systematic review of the literature thematic review and meta-analysis (if possible). WP 2 will identify the themes behind why DNACPR processes fail by examining Coroner Article 43 notices; incidents serious untoward incidents complaints and enquiries from NHS providers and a data from a patient / relative helpline.WP 3 will identify current NHS practices through a review of local Trust DNACPR policies and procedures mapped against national guidelines. It will seek examples of best practice alongside looking for evidence of inequality and inconsistencies. WP 4 will obtain health service providers perspectives on current process. We will use a focus groups to identify understanding of current guidelines and the practical difficulties of implementing policy in clinical practice.WP 5 will pull packages 1-4 together to produce and disseminate a final report. This will be facilitated by a consensus conference with the stakeholder group and representatives of policy makers patient and professional organisations and those responsible for education and development to consider the how these findings will impact on future policy and research in the UK. Following this we will summarise and disseminate the findings of the project setting out the recommendations for best use of available evidence to direct policy and practice highlighting gaps in the evidence base and indicating prioritised future research needs.


Research activity codes: 8.1 ORGANISATION AND DELIVERY OF SERVICES;7.3 MANAGEMENT AND DECISION MAKING
Health categories: GENERIC HEALTH RELEVANCE
Title: NHS Top Managers Knowledge Exchange and Leadership: The Early Development of Academic Health Science Networks
Funder: Department of Health (England)

Abstract: The project will explore the engagement of very senior managers (CEO or senior level managers at Board level or designated senior ASHN leaders; both general managers and clinical managerial hybrids) in knowledge exchange activities of regional Academic Health Science Networks and the national AHSN Forum. We will study a group of senior managers who appear as highly engaged with these activities exploring their motivations biography and influence mechanisms We will focus on their knowledge mobilization activity as a core tracer issue. We will track how these top managers use ‘knowledge about knowledge mobilization’ within their core professional networks and how they act as knowledge leaders. We will plot these networks using Social Network Analysis (SNA) techniques and through semi-structured interviewing. We will finally generate comparative cases plotting the early development of five AHSNs and their knowledge mobilization strategies in real time. We here respond to a call for more understanding of NHS based knowledge linkage and exchange efforts by NIHR HS and DR. The proposal adds to the currently small scale literature on NHS knowledge leadership.


Research activity codes: 8.1 ORGANISATION AND DELIVERY OF SERVICES;8.3 POLICY, ETHICS AND RESEARCH GOVERNANCE
Health categories: GENERIC HEALTH RELEVANCE