NIHRDataInsights/HRCSData huggingface dataset:
Title: Evaluation of the advancing quality pay for performance programme in the NHS North West
Funder: Department of Health (England)

Abstract: Background: Using incentives to influence behaviour can produce benefits for patients but it can have complex and unintended outcomes. From October 2008 hospitals in the North West of England will participate in a scheme which provides financial incentives for quality. This scheme the ‘Advancing Quality’ Programme (AQP) is based on a US initiative which has been shown to improve the quality of care delivered. This study is an evaluation of the AQP initiative.Aims: (1) Provide a wide ranging and in-depth evaluation of AQP in the North West; (2) Identify key lessons for the adoption of PfP systems in the UK NHS; (3) Add to the evidence base concerning PfP systems In order to achieve these aims the four main objectives are to: (1) Identify the impact of AQP on key stakeholders (provider organisations commissioners and patients) and clinical practice; (2) Assess the cost-effectiveness of AQP; (3) Identify the most important barriers to and facilitators of successful AQP implementation; (4) Provide lessons for the wider implementation of PfP schemes across the NHS as a wholeDesign of the study: A multi-method multi-stage design over 5 years. Analyses of national routinely collected data to compare participating hospitals with each other and with controls and over time to quantify the impact of AQP. Analyses of performance against quality targets over time and with controls for a sub-set of performance measures. Assessment of cost effectiveness in terms health gain and financial Return on Investment. Identification of change processes and factors associated with performance using comparative in-depth case narratives.Participants: All 24 acute trusts in the North West of England plus the NW Ambulance Trust and independent providers. NW commissioners.Outcomes: (i) The identification and understanding of the way in which incentive structures impact on the delivery of quality care for NHS patients; (ii) Clear and robust conclusions about the relative effects of incentives or incentive mixes on provider and commissioner roles (iii) Practical recommendations to inform the development of incentive regimes within the NHS (iv) An agenda that establishes the key areas for further research and the appropriate methods that should be used in this research.


Research activity codes: 8.1 ORGANISATION AND DELIVERY OF SERVICES;8.2 HEALTH AND WELFARE ECONOMICS
Health categories: GENERIC HEALTH RELEVANCE
Title: Predictive risk stratification: impact on care for people with or at risk of chronic conditions
Funder: Division for Social Care and Health Research (Wales)

Abstract: New approaches to the management of chronic conditions are needed in order to shift the balance of care from the acute to primary and community sectors and improve services locally. The Welsh Assembly Government (WAG) has commissioned the development of a predictive risk stratification model (PRISM) for Wales to stratify people into one of four risk strata based on having an emergency admission in the following year. PRISM has the capacity to tailor care at individual patient level to patient need. Questions remain however about how the model will be adopted by potential users at each risk strata. The aim of the proposed study is to describe the processes of introducing PRISM in Wales and to estimate the effects on the delivery of care both to patients living with or at risk of developing a chronic condition and to those with no perceived risk. A mixed-method ‘before during and after’ quasi-experimental cohort study will be conducted with Intervention sites and Control sites. Changes following the implementation of PRISM and its acceptability will be measured within the Intervention and Control sites. The Client Service Receipt Inventory questionnaires and routine data from the PRISM dataset will be used to compare services delivered to patients both before and after implementation. Costs of system implementation and of changes in processes of care delivery will be assessed. Focus groups and semi-structured interviews with service providers commissioners and policy makers will explore the individual and organisational processes of change and judge how well PRISM works in supporting better patient care and service planning. The acceptability to patients of the predictive risk stratification approach will be assessed using the Quality of Care Monitor. SF-12 data will be collected at each time point in order to inform the design of a subsequent study to evaluate the effect of implementing PRISM on patient outcomes.


Research activity codes: 8.4 RESEARCH DESIGN AND METHODOLOGIES (HEALTH SERVICES)
Health categories: GENERIC HEALTH RELEVANCE
Title: Integration and Continuity of Primary Care: Polyclinics and Alternatives a Patient-Centred Analysis of How Organisation Constrains Care Coordination
Funder: Department of Health (England)

Abstract: Research design: Multiple nested case studies with systematic cross-sectional comparison between sites. As study sites we will sample one instance of each type of governance structure listed under Background in the detailed research proposal (theoretically-informed sampling). In each site we will make a nested case study describing the linkages between the clinical practices and the governance structures involved in coordinating services for patients needing services from multiple organisations. In each site data collection and analysis will start by describing the coordination (or not) of services at clinical practice level and the factors reported to aid or impede coordination. Working upwards and outwards from clinical practice a wider case study will then trace and describe how the organisational or other contextual causes produce these facilitating or constraining factors. The process will then be repeated connecting the organisational level to its local health system context. The sequence will in each study site produce three nested case studies together describing the interactions between: (1) the clinical care level; (2) provider organisation or service level; and (3) health system level (interactions between whole organisations). In this way we propose to expose more precisely than in previous studies the links mediating governance structures and clinical practice. Findings for each site will then be systematically compared across study sites by applying across them all a standard analytic framework. This will expose similarities and differences between sites i.e. between governance structures in the relationships between governance structures and the coordination of complex care and enable us to make theoretical generalisations from the findings. As a tracer group we select frail elderly people since they make heavy use of complex (multi-provider) care. Data will be collected by interviews of patients professionals and other key informants; content analysis of policy and management documents; and re-analysis of secondary data.


Research activity codes: 8.1 ORGANISATION AND DELIVERY OF SERVICES
Health categories: GENERIC HEALTH RELEVANCE
Title: Collective action for knowledge mobilisation: a realist evaluation of the Collaborations for Leadership in Applied Health Research and Care
Funder: Division for Social Care and Health Research (Wales)

Abstract: This aim of this study is to determine the impact of CLAHRCs in relation to one of their key functions: implementing the findings from research in clinical practice and thereby make a significant contribution to the evidence base about research implementation. The overarching evaluation question is implementation research through CLAHRCs - What works for whom why and in what circumstances? This will be addressed through objectives about implementation processes mechanisms and impact communities of practice and sustained interactions contextual influences and boundary objects. We are also studying the impact of user involvement in the implementation of research within CLAHRCs.


Research activity codes: 8.3 POLICY, ETHICS AND RESEARCH GOVERNANCE
Health categories: GENERIC HEALTH RELEVANCE
Title: Ensuring comparisons of health care providers are fair: risk modelling for quality improvement in the critically ill
Funder: Department of Health (England)

Abstract: Objective 1. To improve current risk prediction models for critically ill patientsDetailed statistical analysis plans will be developed with input from the Expert Group (see: Team Expertise) to address each of the specific points detailed above (or other aspects of modelling identified as important by the Expert Group). Model improvements will be assessed both visually (e.g. by calibration plots) and using a panel of measures of model performance to encompass discrimination (c index or area under the ROC curve) calibration (Hosmer-Lemeshow test) and overall fit (Briers score Shapiros Q R-squared) using bootstrap methods to adjust these measures for overfitting to the data.Objective 2. To develop new risk prediction models for critically ill patientsLearning from Objective 1 of the project will feed into the methods used for development of new models. Clinicians in the relevant fields will be consulted for their input into the design of the risk prediction models. Models will be developed to maximise predictive performance while considering ease of use.Objective 3. Immediate translation of research results into practiceRisk models developed through this project will immediately be implemented into the routine comparative reporting for both the CMP and NCAA. Results will be presented at the Annual Meetings for both the CMP and NCAA for participating units/hospitals supported by regular data collection training for both audits and to academic and policy audiences throught the joint Health Services Research Network/NIHR SDO Programme meetings. Enthusiasm suggests that new audits will be established on a cost-recovery basis for new areas (e.g. cardiothoracic critical care).Timeline:Jan 2011-Dec 2011 - Objective 1 (Expert group meetings- Mar 2011 Sep 2011)Jan 2012-Oct 2012 - Objective 2 (Expert group meetings- Mar 2012 Sep 2012)Apr 2012 - Objective 3: Presentation of results of Objective 1 at the Annual Meeting of the CMPNov 2012-Dec 2012 - Objective 3: Completion of final report and wider dissemination of results


Research activity codes: 7.3 MANAGEMENT AND DECISION MAKING;8.4 RESEARCH DESIGN AND METHODOLOGIES (HEALTH SERVICES)
Health categories: GENERIC HEALTH RELEVANCE
Title: Measuring Harm and Informing Quality Improvement Longitudinally in the Welsh NHS
Funder: Division for Social Care and Health Research (Wales)

Abstract: Wales is currently in a unique position in relation to harm measurement; data is already being collected on a monthly basis across all NHS organisations in Wales. NHS staff will undertake around 5000 GTT reviews in the first two years of the study. The research team will use this infrastructure and an independent research team will follow the local review teams in examining the same inpatient records for harm. The project has two discrete phases:Phase 1: Comparative studyEstablished review teams will continue to undertake GTT reviews from all organisations across Wales. No changes will be made to current practice and protocol. Once a trigger is identified in the notes the reviewers will examine the notes in further detail to identify if harm has occurred and rate its severity. The research team will undertake a subsequent review process in two stages. Stage 1 will involve trained nurses screening patient records using Review Form 1 (RF1) consisting of a list of eighteen explicit criteria. Positive identification of one or more of the criteria is viewed as an indicator of a potential adverse event and the case note review proceeds to stage 2 where physicians will use the RF2 screening tool to judge the occurrence nature preventability and consequences of the referred event on a per diem basis. A six-point scale will be used to assess the likelihood of a causative link between the event and injury and the likelihood that the event was preventable. Phase 2: Definitive National Harm MeasurementExamination of the data generated in phase 1 will inform the methodological approach taken in stage 2 i.e. the tool to be used and the stratification of reviews by hospital size and throughput. Phase two involves a unique partnership between the NHS and the research team to examine around 5000 inpatient episodes for harm over two consecutive years.This study aims to support the Welsh NHS in monitoring the quality and safety of the services it provides. It is clear that system failures and causes of harm cannot be addressed efficiently until issues are identified. Further quantification of the nature and extent of the problem provides the basis from which solutions and intervention programmes can be developed and subsequently monitored and evaluated.


Research activity codes: 8.1 ORGANISATION AND DELIVERY OF SERVICES
Health categories: GENERIC HEALTH RELEVANCE
Title: Can valid and practical risk-prediction or casemix adjustment models including adjustment for co-morbidity be generated from English hospital administrative data (Hospital Episode Statistics)?
Funder: Department of Health (England)

Abstract: Using routine NHS hospital admissions data (Hospital Episode Statistics HES) we aim to derive a series of predictive models for in-hospital mortality unplanned readmission unplanned reoperation and non-attendance in outpatients departments. For the last three of these there is a need to define them in terms of ICD/OPCS codes and time lags so that they will be of most use to the NHS. There will be a focus on the measurement of and adjustment for comorbidity including an update of the popular Charlson index which we will calibrate for use in the NHS. We will use not just traditional logistic regression but machine learning methods such as artificial neural networks which have shown promising results with other datasets and are particularly suited to looking for hidden relations between variables. The outcome measures will be specified empirically from the data but with input from clinical and coding experts. These models will be based on national data and will therefore allow us to observe the variation between hospitals in mortality and each of the other outcome measures. This benchmarking will help the NHS and its hospitals drive quality improvement in accordance with the NHS Next Stage Review. At an individual patient level knowledge of their risk of adverse outcomes such as these aids clinical decision making and informs clinical discussion. The models from this project could be used for both purposes.HES now captures some 60 million OPD appointments each year since 2003/4. The quality of this interesting new resource is uncertain however. As well as answering the questions concerning optimal time lag and outcomes in non-attenders this project will afford valuable experience in the use of these data in prediction of non-attendance and health services research in general.


Research activity codes: 8.1 ORGANISATION AND DELIVERY OF SERVICES
Health categories: GENERIC HEALTH RELEVANCE
Title: Measuring prevalence reliability and variation in high risk prescribing in general practice using multilevel modelling in a population database
Funder: Chief Scientist Office (Scotland)

Abstract: The study is needed because primary care prescribing is a significant source of patient harm and improving patient safety is a priority for the NHS. Measurement is the first step on the road to improving safety but it is important that measures are valid reliable and suitable for their intended purpose. The study aim is to define and implement a set of indicators of high-risk prescribing in existing electronic clinical data in order determine their validity for safety improvement clinical governance and appraisal/revalidation purposes. The overall study design is a cross-sectional analysis of a large dataset extracted from existing general practice electronic clinical records.The first objective is to define and operationalise an appropriate set of indicators. We will achieve this by iteratively cycling between discussing candidate indicators and specifications with an expert advisory group and operationalising these indicators in real-life clinical data. The second objective is to measure the prevalence of high risk prescribing for both individual and composite measures and to examine associations between high risk prescribing and patient prescriber and practice characteristics. To achieve this we will use both univariate descriptive analysis and explore variation between prescribers and practices before and after adjustment for patient characteristics using multilevel modelling. The final objective is to measure the reliability of individual and composite indicators at prescriber and practice level.There are several outputs of relevance to the NHS and specifically those involved in prescribing improvement clinical governance and revalidation of doctors. First the study will produce specifications for a set of evidence based indicators that can be applied to existing GP electronic data throughout the UK. Second it will define the scale of the problem of general practice high risk prescribing. Third it will generate information to inform whether improvement and governance activity should target high risk prescribers or practices or seek to shift the whole distribution of prescribers and practices. Finally it will provide evidence of the reliability of indicators for different purposes including collaborative quality improvement and clinical governance.


Research activity codes: 8.4 RESEARCH DESIGN AND METHODOLOGIES (HEALTH SERVICES);8.3 POLICY, ETHICS AND RESEARCH GOVERNANCE
Health categories: GENERIC HEALTH RELEVANCE
Title: RAPPORT: ReseArch with Patient and Public invOlvement: a RealisT evaluation
Funder: Department of Health (England)

Abstract: Public involvement in research is a complex phenomenon which needs a method of enquiry capable of capturing the interplay between outcomes processes and the context in which it is conducted. The research team has extensive experience of complex evaluations and drawing on previous experience the proposed research will therefore use a realist evaluation approach [2223] to investigate what type of public involvement provides what kind of outcome in relation to different types of research and settings. To capture wide variation in the range and scope of public involvement in research we have identified 4 regions that offer multiple opportunities for comparison in terms of geographical diversity levels of research activity and the presence or absence of systems of public involvement in research embedded in academic or health service organizations. We will focus on 6 exemplar topic areas; cystic fibrosis diabetes arthritis dementia learning disabilities and public health. These topic areas have been selected to ensure maximum variation in research settings methodologies funding sources and public involvement activities.The proposed research will be conducted in 3 stages. In stage 1 a national scoping of the 6 topic areas will be undertaken of current studies registered on the UK PubMed Central Database. We will also search for studies completed within the past 2 years. Available study documentation will be analysed to investigate the extent and range of reported public involvement. In stage 2 we will select the lead researchers from the studies located in the 4 regions. They will be surveyed to discover how PI in their research has been developed their ideas about what it has contributed and its impact on their findings. Using a case study approach [29] 20 studies that are ongoing or completed within the past 2 years will be selected for indepth analysis in stage 3. A variety of data will be collected in order to understand the context processes and impacts of PI in each study. This will include documentary analysis (e.g. advisory group meeting notes) and semi-structured interviews with key informants including researchers PI members clinical partners and funding organizations link person. We will use the Normalization Process Theory toolkit [27] to record issues in the implementation of PI as visible radar plots. Over 18 months we will track ongoing studies by a monthly focused telephone interview and will re-evaluate radar plots to capture any changes in PI processes. Comparative case study analysis will be used to identify and explain patterns across and within organizations and case study.


Research activity codes: 8.3 POLICY, ETHICS AND RESEARCH GOVERNANCE
Health categories: GENERIC HEALTH RELEVANCE
Title: Care and communication between health professionals and patients affected by severe or chronic illness in community care settings: A qualitative study of care at the end of life.
Funder: Department of Health (England)

Abstract: Care and treatment at the end of life is often inadequate and crisis driven. Unnecessary and inappropriate interventions and unscheduled hospital admissions are distressing for terminally ill patients and their families and add to costs and pressure on scarce NHS resources. The National End of Life Care (EOLC) Strategy promotes the use of Advance Care Planning (ACP) as a means of addressing these issues and enabling proactive rather than reactive care. The initiation of ACP is recognized to be a critical juncture in patient care and challenging for all participants. The proposed research will extend the very limited evidence regarding initiation of ACP in community settings by recruiting patients with a range of conditions and associated EOLC needs. Research question: How do patients carers and professionals experience the initiation of advance care planning and outcomes for end of life care in the context of an implemented end of life care pathway in community care settings? Objectives: 1) to investigate patient and professional perceptions and experiences of initiating and subsequently reviewing ACP discussions and decisions throughout the last six months of life; 2) to investigate patient and carer perceptions of and responses to the offer of an ACP discussion; 3) to identify barriers to the implementation of ACP; 4) to investigate outcomes of EOLC: how patient preferences in ACP match the care received; 5) to investigate how professionals patients and carers assess the quality of EOLC; 6) to generate evidence for best practice in ACP; 7) to establish further training and support needs for professionals to communicate with patients and carers in ACP discussions with confidence and skill. Setting: Eight general practices within Nottinghamshire through which professional and patient respondents will be recruited. Method: Qualitative study involving 2 workstreams: 1) Professional Perspective Interviews: Interviews with a purposively selected sample of ~30 health care professionals (HCP) providing EOLC in community settings. 2) Patient-Centred Case Studies: longtitudinal prospective follow-up of ~20 patients carers and key health care professionals to explore the process of ACP and service delivery in the last 6 months of life. Analysis: 1). Comparative thematic analysis of patient carer and professional interview sets. 2). Patient-centred case studies will be i) incorporated within a systematic cross case comparison and ii) the subject of a holistic in depth analysis of the process of ACP and its outcomes. Outcome: an understanding of i). how ACP is conducted in real world settings; ii) patient/carer preferences for ACP; 3) how ACP shapes delivery of EOLC; 4) professional needs for further training and support to undertake ACP.


Research activity codes: 7.2 END OF LIFE CARE
Health categories: GENERIC HEALTH RELEVANCE