Title: Associations between Research Activity and Patient Health Outcomes (ARAPAHO)
Funder: Department of Health and Social Care

Abstract: Background Research is fundamental to improving quality of care. Although research traditionally has impact through implementation into routine care, there is increasing interest in whether participation in research itself drives better performance. The bulk of patient contacts are through general practice. If research participation improves outcomes, achieving those benefits through general practice could improve population health. However, the evidence that research activity improves outcomes mostly comes from secondary care. The same benefits may not occur in general practice. There is a need to use the wealth of data on research activity and general practice outcomes to provide a comprehensive analysis of the relationship between research activity and patient care. Research questions We will answer the following research questions: 1. Are there associations between research activity in general practice and patient outcomes? 2. What possible mechanisms may explain the associations between research activity and patient outcomes? 3. What are the characteristics of effective research active general practices from the perspective of staff, practitioners and patients? 4. What are the impacts on patients and staff of research activity in general practice? 5. How can research in general practice be encouraged and supported? What factors facilitate or inhibit research activity in general practice? Methods We propose a project with two linked workpackages, creating two main reports at 6 months and at project end (24 months). We will work closely with patient groups in our research sites to ensure our work is sensitive to the issues that they think are most important. Workpackage 1 &ndash; Analysis of the relationship between research activity and outcomes Workpackage 1 will make an initial assessment of the relationship between research activity and patient outcomes We will undertake scoping work to develop a logic model support our thinking about how research activity impacts on outcomes. We will conduct a rapid analysis of existing data on the link between research activity and outcomes in general practice, to deliver a report in the first 6 months. Over the remaining time, we will continue to conduct analyses, using a wider range of datasets, and using various causal modelling techniques to examine whether these associations are plausibly causal, and what mechanisms might underlie them. Workpackage 2 &ndash; Patient and professional perspectives on research activity in primary care and the links to outcomes Workpackage 2 will provide an in-depth assessment of the perspectives of patients and professionals on this issue. Using the outputs from earlier work and working closely with patients and other stakeholders, we will identify general practices for in-depth study. We will sample practices from areas with high disease burden and with geographical spread, and our team will undertake in-depth research in around 6-8 practices in our three sites. Anticipated impact and dissemination For the final report, we will synthesise data from both workpackages, working closely with our patient and advisory groups. We will explore the implications of our findings for the Primary Care Network contract, CQC inspections and the uptake of existing schemes such as CPRD and Research Ready status.

Lay abstract: Although much NHS care is outstanding, in some areas the NHS lags behind other countries, and sometimes care in one part of the country is not as good as others. Research is really important to improve quality, by helping the NHS find better ways of delivering care. However, putting research into practice takes time. Evidence suggests that when NHS hospitals take part in research, the fact that they take part may lead to better quality care for the patients in that hospital, even while the research is being done. This suggests that we may be able to improve quality of care by helping NHS organisations take part in research. That would be a win-win , because we would get research evidence more quickly, and drive up quality of care at the same time. However, most of this evidence of the link between research activity and quality comes from hospitals. Although many people use hospitals, many more visit general practice for their care. If taking part in research improved quality in general practice, the benefits could be large. But we cannot assume that any link we find in hospitals will be the same in general practice. We will answer 5 questions: &bull; Do practices taking part in more research provide better quality of care? &bull; How might taking part in research improve quality? &bull; What do patients and staff think makes a good research practice? &bull; What are the impacts on patients and staff from being in a research practice? &bull; How can research in general practice be supported? We will do this research in two ways. First, we will use data from general practices in England to see whether practices that do research provide better quality of care. We will report back to the funders, GP organisations and patients after 6 months. We will then use this data to see what makes practices take part in research, and whether it is taking part in research that leads these practices to provide better quality care. Secondly, we will use the data to find practices with different profiles, and talk to the staff and patients. We will ask them about their experience of doing research, and how research impacts on care. We will try to understand how to support practices to do research. We will work closely with patients, setting up a patient group who will meet throughout the project. They can help us ask the right questions which are most important to them, develop materials that are easy to understand, make sense of our results, and explain the results to the wider public. Throughout our study, we will write reports and meet with stakeholders to keep everyone informed about our progress.

Research activity codes: 8.1 ORGANISATION AND DELIVERY OF SERVICES
Health categories: GENERIC HEALTH RELEVANCE