Health Services and Delivery Research最新文献

{"title":"The transition from children’s services to adult services for young people with attention deficit hyperactivity disorder: the CATCh-uS mixed-methods study","authors":"A. Janssens, H. Eke, A. Price, T. Newlove-Delgado, S. Blake, C. Ani, P. Asherson, B. Beresford, T. Emmens, C. Hollis, S. Logan, M. Paul, K. Sayal, S. Young, T. Ford","doi":"10.3310/hsdr08420","DOIUrl":"https://doi.org/10.3310/hsdr08420","url":null,"abstract":"Background Attention deficit hyperactivity disorder was previously seen as a childhood developmental disorder, so adult mental health services were not set up to support attention deficit hyperactivity disorder patients who became too old for child services. To our knowledge, this is the first in-depth study of the transition of attention deficit hyperactivity disorder patients from child to adult health services in the UK. Objectives Our objectives were to explore how many young people with attention deficit hyperactivity disorder are in need of services as an adult, what adult attention deficit hyperactivity disorder services are available and how attention deficit hyperactivity disorder stakeholders experience transition from child to adult services. Design An interactive mixed-method design was adopted with three study streams: (1) a 12-month surveillance study with 9-month follow-up to find out how many young people required ongoing medication when they were too old for child services (929 surveys completed by children’s clinicians); (2) a mapping study to identify and describe services for young adults with attention deficit hyperactivity disorder (2686 respondents to online surveys for patients and health workers and freedom of information requests to service providers and commissioners); and (3) a qualitative study to explore key stakeholders’ experiences of transition from child to adult services (144 interviews with 64 attention deficit hyperactivity disorder patients, 28 parents and 52 health clinicians; 38 working in child or adult secondary health services and 14 general practitioners). Members of the public advised at each stage of the study. Results When corrected for non-response and case ascertainment, the annual number of young people with an ongoing need for medication for attention deficit hyperactivity disorder lies between 270 and 599 per 100,000 people aged 17–19 years. Among 315 individuals eligible for transition, 64% were accepted, but only 22% attended their first adult services appointment. Our interactive map describes 294 unique services for adults with attention deficit hyperactivity disorder across the UK, of which 44 are ‘dedicated’ attention deficit hyperactivity disorder services. Few services provide the full range of recommended provision; most focus on diagnosis and medication. Services are unevenly distributed across the UK, with nearly all ‘dedicated’ services being in England. Exploring stakeholders’ experiences revealed how invested the stakeholders are in continuing attention deficit hyperactivity disorder treatment and how the architecture of services affects transition. An association between attention deficit hyperactivity disorder, education and continuance of medication into young adulthood, plus parent involvement and feeling prepared for transition and adult life with attention deficit hyperactivity disorder, influenced investment. However, even with investment, how accessible adult services are, ","PeriodicalId":12880,"journal":{"name":"Health Services and Delivery Research","volume":"8 1","pages":"1-154"},"PeriodicalIF":0.0,"publicationDate":"2020-11-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"45643665","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The effects of interoperable information technology networks on patient safety: a realist synthesis","authors":"J. Keen, M. Abdulwahid, Natalie King, Judy M. Wright, R. Randell, Peter H Gardner, J. Waring, R. Longo, S. Nikolova, C. Sloan, J. Greenhalgh","doi":"10.3310/hsdr08400","DOIUrl":"https://doi.org/10.3310/hsdr08400","url":null,"abstract":"\u0000 \u0000 Interoperable networks connect information technology systems of different organisations, allowing professionals in one organisation to access patient data held in another one. Health policy-makers in many countries believe that they will improve the co-ordination of services and, hence, the quality of services and patient safety. To the best of our knowledge, there have not been any previous systematic reviews of the effects of these networks on patient safety.\u0000 \u0000 \u0000 \u0000 The aim of the study was to establish how, why and in what circumstances interoperable information technology networks improved patient safety, failed to do so or increased safety risks. The objectives of the study were to (1) identify programme theories and prioritise theories to review; (2) search systematically for evidence to test the theories; (3) undertake quality appraisal, and use included texts to support, refine or reject programme theories; (4) synthesise the findings; and (5) disseminate the findings to a range of audiences.\u0000 \u0000 \u0000 \u0000 Realist synthesis, including consultation with stakeholders in nominal groups and semistructured interviews.\u0000 \u0000 \u0000 \u0000 Following a stakeholder prioritisation process, several domains were reviewed: older people living at home requiring co-ordinated care, at-risk children living at home and medicines reconciliation services for any patients living at home. The effects of networks on services in health economies were also investigated.\u0000 \u0000 \u0000 \u0000 An interoperable network that linked at least two organisations, including a maximum of one hospital, in a city or region.\u0000 \u0000 \u0000 \u0000 Increase, reduction or no change in patients’ risks, such as a change in the risk of taking an inappropriate medication.\u0000 \u0000 \u0000 \u0000 We did not find any detailed accounts of the ways in which interoperable networks are intended to work and improve patient safety. Theory fragments were identified and used to develop programme and mid-range theories. There is good evidence that there are problems with the co-ordination of services in each of the domains studied. The implicit hypothesis about interoperable networks is that they help to solve co-ordination problems, but evidence across the domains showed that professionals found interoperable networks difficult to use. There is insufficient evidence about the effectiveness of interoperable networks to allow us to establish how and why they affect patient safety.\u0000 \u0000 \u0000 \u0000 The lack of evidence about patient-specific measures of effectiveness meant that we were not able to determine ‘what works’, nor any variations in what works, when interoperable networks are deployed and used by health and social care professionals.\u0000 \u0000 \u0000 \u0000 There is a dearth of evidence about the effects of interoperable networks on patient safety. It is not clear if the networks are associated with safer treatment and care, have no effects or increase clinical risks.\u0000 \u0000 \u0000 \u0000 Possible future research includes primary studies of the effectiveness of interoperable networks, o","PeriodicalId":12880,"journal":{"name":"Health Services and Delivery Research","volume":"8 1","pages":"1-162"},"PeriodicalIF":0.0,"publicationDate":"2020-11-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"47602932","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Seizure first aid training for people with epilepsy attending emergency departments and their significant others: the SAFE intervention and feasibility RCT","authors":"A. Noble, S. Nevitt, Emily Holmes, L. Ridsdale, M. Morgan, C. Tudur-Smith, D. Hughes, S. Goodacre, T. Marson, Darlene A Snape","doi":"10.3310/hsdr08390","DOIUrl":"https://doi.org/10.3310/hsdr08390","url":null,"abstract":"Background No seizure first aid training intervention exists for people with epilepsy who regularly attend emergency departments and their significant others, despite such an intervention’s potential to reduce clinically unnecessary and costly visits. Objectives The objectives were to (1) develop Seizure first Aid training For Epilepsy (SAFE) by adapting a broader intervention and (2) determine the feasibility and optimal design of a definitive randomised controlled trial to test SAFE’s efficacy. Design The study involved (1) the development of an intervention informed by a co-design approach with qualitative feedback and (2) a pilot randomised controlled trial with follow-ups at 3, 6 and 12 months and assessments of treatment fidelity and the cost of SAFE’s delivery. Setting The setting was (1) third-sector patient support groups and professional health-care organisations and (2) three NHS emergency departments in England. Participants Participants were (1) people with epilepsy who had visited emergency departments in the prior 2 years, their significant others and emergency department, paramedic, general practice, commissioning, neurology and nursing representatives and (2) people with epilepsy aged ≥ 16 years who had been diagnosed for ≥ 1 year and who had made two or more emergency department visits in the prior 12 months, and one of their significant others. Emergency departments identified ostensibly eligible people with epilepsy from attendance records and patients confirmed their eligibility. Interventions Participants in the pilot randomised controlled trial were randomly allocated 1 : 1 to SAFE plus treatment as usual or to treatment as usual only. Main outcome measures Consent rate and availability of routine data on emergency department use at 12 months were the main outcome measures. Other measures of interest included eligibility rate, ease with which people with epilepsy could be identified and routine data secured, availability of self-reported emergency department data, self-reported emergency department data’s comparability with routine data, SAFE’s effect on emergency department use, and emergency department use in the treatment as usual arm, which could be used in sample size calculations. Results (1) Nine health-care professionals and 23 service users provided feedback that generated an intervention considered to be NHS feasible and well positioned to achieve its purpose. (2) The consent rate was 12.5%, with 53 people with epilepsy and 38 significant others recruited. The eligibility rate was 10.6%. Identifying people with epilepsy from attendance records was resource intensive for emergency department staff. Those recruited felt more stigmatised because of epilepsy than the wider epilepsy population. Routine data on emergency department use at 12 months were secured for 94.1% of people with epilepsy, but the application process took 8.5 months. Self-reported emergency department data were available for 66.7% of people with e","PeriodicalId":12880,"journal":{"name":"Health Services and Delivery Research","volume":"8 1","pages":"1-190"},"PeriodicalIF":0.0,"publicationDate":"2020-10-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"45868607","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Psychosocial support for families of children with neurodisability who have or are considering a gastrostomy: the G-PATH mixed-methods study","authors":"G. Craig, E. Hajdukova, C. Harding, C. Flood, C. McCourt, D. Sellers, J. Townsend, D. Moss, C. Tuffrey, Bryony Donaldson, M. Cole, A. Gill","doi":"10.3310/hsdr08380","DOIUrl":"https://doi.org/10.3310/hsdr08380","url":null,"abstract":"BackgroundEvidence reviews recommend consistent and structured support for children with neurodisability and their caregivers in care pathways in which professionals recommend a gastrostomy feeding tube. To date, and to our knowledge, no research has shown how these recommendations have been implemented.ObjectivesThe objectives were to describe different exemplar models of psychosocial support and provide an estimate of their resources and costs.DesignThis was a mixed-methods study involving (1) a web-based survey, (2) a qualitative, collective case study of psychosocial support provision in four services and (3) an estimate of costs and preference through a willingness-to-pay study.SettingFour service configurations in different locations in England and Scotland.ParticipantsParticipants were staff who responded to a survey (n = 67) and interviewees (staff, n = 58; parents/children, n = 29).FindingsPsychosocial support was rarely formalised or documented; it was delivered by different members of the multidisciplinary team, rather than by designated staff, and it was often integrated into appointments dominated by clinical care. Parents expressed different needs for support but reported little opportunity to discuss emotional aspects. Psychologists were not routinely involved and, in general, families were underserved by psychosocial services. Professionals constructed families’ need for psychosocial support in terms of their own roles and the management of risk. Mechanisms for integrating and delivering support were identified, including models of care that linked community and tertiary health services and integrated health and education through pooled budgets. Although generally valued by both staff and parents, peer-to-peer parent support was not consistently offered. Barriers included concerns about confidentiality and appropriately matching parents. Parents participated as members of a feeding committee at one site. Three analytical constructs described the provision of psychosocial support: ‘hidden work’, expressing emotional vulnerability and negotiations around risks and values. The cost-of-support study found that there was a mean of 2.25 appointments (n = 8 parents or carers) over the previous 12 months. The cost of health-care professionals’ time spent on providing psychosocial support ranged from £0.00 to £317.37 per child per year, with an average cost of £76.42, at 2017 prices. In the willingness-to-pay study the median rank of enhanced support, involving the opportunity to see a psychologist and parental peers, was significantly higher than that of usual care (n = 96 respondents, both carers and professionals, who completed rating of the service; p < 0.001).LimitationsIt proved difficult to disseminate a national survey, which resulted in a small number of returns, and to cost the provision of psychosocial support, which we designated as ‘hidden work’, owing to the lack of recording in clinical systems. Moreover, estimates were base","PeriodicalId":12880,"journal":{"name":"Health Services and Delivery Research","volume":"8 1","pages":"1-126"},"PeriodicalIF":0.0,"publicationDate":"2020-10-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"46620561","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Social norms interventions to change clinical behaviour in health workers: a systematic review and meta-analysis","authors":"S. Cotterill, M. Y. Tang, R. Powell, E. Howarth, L. McGowan, Jane Roberts, B. Brown, S. Rhodes","doi":"10.3310/hsdr08410","DOIUrl":"https://doi.org/10.3310/hsdr08410","url":null,"abstract":"\u0000 \u0000 A social norms intervention seeks to change the clinical behaviour of a target health worker by exposing them to the values, beliefs, attitudes or behaviours of a reference group or person. These low-cost interventions can be used to encourage health workers to follow recommended professional practice.\u0000 \u0000 \u0000 \u0000 To summarise evidence on whether or not social norms interventions are effective in encouraging health worker behaviour change, and to identify the most effective social norms interventions.\u0000 \u0000 \u0000 \u0000 A systematic review and meta-analysis of randomised controlled trials.\u0000 \u0000 \u0000 \u0000 The following databases were searched on 24 July 2018: Ovid MEDLINE (1946 to week 2 July 2018), EMBASE (1974 to 3 July 2018), Cumulative Index to Nursing and Allied Health Literature (1937 to July 2018), British Nursing Index (2008 to July 2018), ISI Web of Science (1900 to present), PsycINFO (1806 to week 3 July 2018) and Cochrane trials (up to July 2018).\u0000 \u0000 \u0000 \u0000 Health workers took part in the study.\u0000 \u0000 \u0000 \u0000 Behaviour change interventions based on social norms.\u0000 \u0000 \u0000 \u0000 Health worker clinical behaviour, for example prescribing (primary outcome), and patient health outcomes, for example blood test results (secondary), converted into a standardised mean difference.\u0000 \u0000 \u0000 \u0000 Titles and abstracts were reviewed against the inclusion criteria to exclude any that were clearly ineligible. Two reviewers independently screened the remaining full texts to identify relevant papers. Two reviewers extracted data independently, coded for behaviour change techniques and assessed quality using the Cochrane risk-of-bias tool. We performed a meta-analysis and presented forest plots, stratified by behaviour change technique. Sources of variation were explored using metaregression and network meta-analysis.\u0000 \u0000 \u0000 \u0000 A total of 4428 abstracts were screened, 477 full texts were screened and findings were based on 106 studies. Most studies were in primary care or hospitals, targeting prescribing, ordering of tests and communication with patients. The interventions included social comparison (in which information is given on how peers behave) and credible source (which refers to communication from a well-respected person in support of the behaviour). Combined data suggested that interventions that included social norms components were associated with an improvement in health worker behaviour of 0.08 standardised mean differences (95% confidence interval 0.07 to 0.10 standardised mean differences) (n = 100 comparisons), and an improvement in patient outcomes of 0.17 standardised mean differences (95% confidence interval 0.14 to 0.20) (n = 14), on average. Heterogeneity was high, with an overall I\u0000 2 of 85.4% (primary) and 91.5% (secondary). Network meta-analysis suggested that three types of social norms intervention were most effective, on average, compared with control: credible source (0.30 standardised mean differences, 95% confidence interval 0.13 to 0.47); social comparison combined with soc","PeriodicalId":12880,"journal":{"name":"Health Services and Delivery Research","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2020-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"42530422","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"An online supported self-management toolkit for relatives of people with psychosis or bipolar experiences: the IMPART multiple case study","authors":"F. Lobban, D. Appelbe, Victoria Appleton, G. Aref-Adib, J. Barraclough, J. Billsborough, N. Fisher, Sheena Foster, Bethany Gill, D. Glentworth, C. Harrop, Sonia Johnson, Steven H. Jones, T. Z. Kovacs, Elizabeth Lewis, Barbara Mezes, Charlotte Morton, E. Murray, Puffin O’Hanlon, V. Pinfold, J. Rycroft-Malone, R. Siddle, Jo Smith, C. Sutton, Pietro Viglienghi, Andrew Walker, C. Wintermeyer","doi":"10.3310/HSDR08370","DOIUrl":"https://doi.org/10.3310/HSDR08370","url":null,"abstract":"Fiona Lobbano ,1* Duncan Appelbeo ,2 Victoria Appletono ,1 Golnar Aref-Adibo ,3 Johanna Barraclougho ,1 Julie Billsborougho ,4 Naomi R Fishero ,1† Sheena Fostero ,4 Bethany Gillo ,1 David Glentworth,5 Chris Harropo ,5 Sonia Johnsono ,3 Steven H Joneso ,1 Tibor Z Kovacso ,5 Elizabeth Lewiso ,1 Barbara Mezeso ,1 Charlotte Mortono ,3 Elizabeth Murrayo ,6 Puffin O’Hanlono ,3 Vanessa Pinfoldo ,4 Jo Rycroft-Maloneo ,7 Ronald Siddleo ,5 Jo Smitho ,8 Chris J Suttono ,9 Pietro Viglienghio ,5 Andrew Walkero1 and Catherine Wintermeyero1","PeriodicalId":12880,"journal":{"name":"Health Services and Delivery Research","volume":"8 1","pages":"1-248"},"PeriodicalIF":0.0,"publicationDate":"2020-09-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"46424726","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Immediate versus delayed short-term integrated palliative care for advanced long-term neurological conditions: the OPTCARE Neuro RCT","authors":"N. Hepgul, Rebecca Wilson, D. Yi, C. Evans, S. Bajwah, V. Crosby, A. Wilcock, Fiona Lindsay, A. Byrne, C. Young, K. Groves, Clare Smith, R. Burman, K. Chaudhuri, E. Silber, I. Higginson, W. Gao, Optcare Neuro","doi":"10.3310/hsdr08360","DOIUrl":"https://doi.org/10.3310/hsdr08360","url":null,"abstract":"1Cicely Saunders Institute of Palliative Care, Policy & Rehabilitation, King’s College London, London, UK 2Sussex Community NHS Foundation Trust, Brighton, UK 3Department of Palliative Medicine, Nottingham University Hospitals NHS Trust, Nottingham, UK 4Faculty of Medicine and Health Sciences, University of Nottingham, Nottingham, UK 5Martlets Hospice, Hove, UK 6Marie Curie Palliative Care Research Centre, Cardiff University, Cardiff, UK 7Department of Neurology, The Walton Centre NHS Foundation Trust, Liverpool, UK 8Queenscourt Hospice, Southport, UK 9Department of Palliative Care, Ashford and St. Peter’s Hospitals NHS Foundation Trust, Surrey, UK 10Department of Palliative Care, King’s College Hospital, London, UK 11National Parkinson Foundation Centre of Excellence, King’s College Hospital and King’s College London, London, UK 12Department of Neurology, King’s College Hospital, London, UK","PeriodicalId":12880,"journal":{"name":"Health Services and Delivery Research","volume":"8 1","pages":"1-80"},"PeriodicalIF":0.0,"publicationDate":"2020-09-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"47274095","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Using co-production to increase activity in acute stroke units: the CREATE mixed-methods study","authors":"F. Jones, K. Gombert-Waldron, S. Honey, G. Cloud, Ruth Harris, A. Macdonald, C. McKevitt, G. Robert, D. Clarke","doi":"10.3310/hsdr08350","DOIUrl":"https://doi.org/10.3310/hsdr08350","url":null,"abstract":"1Centre for Health and Social Care Research, Faculty of Health, Social Care and Education, Kingston University and St George’s, University of London, London, UK 2Leeds Institute of Health Sciences, University of Leeds, Leeds, UK 3Alfred Health, Melbourne, VIC, Australia 4Department of Adult Nursing, King’s College London, London, UK 5School of Design, Glasgow School of Art, Glasgow, UK 6School of Population Health and Environmental Sciences, Faculty of Life Sciences and Medicine, King’s College London, London, UK","PeriodicalId":12880,"journal":{"name":"Health Services and Delivery Research","volume":"8 1","pages":"35"},"PeriodicalIF":0.0,"publicationDate":"2020-09-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"43204885","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Publication and related bias in quantitative health services and delivery research: a multimethod study","authors":"A. Ayorinde, Iestyn Williams, R. Mannion, F. Song, M. Skrybant, R. Lilford, Yen-Fu Chen","doi":"10.3310/hsdr08330","DOIUrl":"https://doi.org/10.3310/hsdr08330","url":null,"abstract":"Publication and related bias in quantitative health services and delivery research: a multimethod study Abimbola A Ayorindeo ,1 Iestyn Williamso ,2 Russell Manniono ,2 Fujian Songo ,3 Magdalena Skrybanto ,4 Richard J Lilfordo 4 and Yen-Fu Cheno 1* 1Division of Health Sciences, Warwick Medical School, University of Warwick, Coventry, UK 2Health Services Management Centre, School of Social Policy, University of Birmingham, Birmingham, UK 3Norwich Medical School, University of East Anglia, Norwich, UK 4Institute of Applied Health Research, University of Birmingham, Birmingham, UK *Corresponding author Y-F.Chen@warwick.ac.uk Background: Bias in the publication and reporting of research findings (referred to as publication and related bias here) poses a major threat in evidence synthesis and evidence-based decision-making. Although this bias has been well documented in clinical research, little is known about its occurrence and magnitude in health services and delivery research. Objectives: To obtain empirical evidence on publication and related bias in quantitative health services and delivery research; to examine current practice in detecting/mitigating this bias in health services and delivery research systematic reviews; and to explore stakeholders’ perception and experiences concerning such bias. Methods: The project included five distinct but interrelated work packages. Work package 1 was a systematic review of empirical and methodological studies. Work package 2 involved a survey (meta-epidemiological study) of randomly selected systematic reviews of health services and delivery research topics (n = 200) to evaluate current practice in the assessment of publication and outcome reporting bias during evidence synthesis. Work package 3 included four case studies to explore the applicability of statistical methods for detecting such bias in health services and delivery research. In work package 4 we followed up four cohorts of health services and delivery research studies (total n = 300) to ascertain their publication status, and examined whether publication status was associated with statistical significance or perceived ‘positivity’ of study findings. Work package 5 involved key informant interviews with diverse health services and delivery research stakeholders (n = 24), and a focus group discussion with patient and service user representatives (n = 8). Results: We identified only four studies that set out to investigate publication and related bias in health services and delivery research in work package 1. Three of these studies focused on health informatics research and one concerned health economics. All four studies reported evidence of the existence of this bias, but had methodological weaknesses. We also identified three health services and delivery research systematic reviews in which findings were compared between published and grey/unpublished literature. These reviews found that the quality and volume of evidence and effect estimates ","PeriodicalId":12880,"journal":{"name":"Health Services and Delivery Research","volume":"8 1","pages":"1-134"},"PeriodicalIF":0.0,"publicationDate":"2020-09-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41751521","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Temporal variations in quality of acute stroke care and outcomes in London hyperacute stroke units: a mixed-methods study","authors":"R. Simister, G. Black, M. Melnychuk, A. Ramsay, A. Baim-Lance, D. Cohen, J. Eng, P. Xanthopoulou, Martin M. Brown, A. Rudd, Stephen Morris, N. Fulop","doi":"10.3310/hsdr08340","DOIUrl":"https://doi.org/10.3310/hsdr08340","url":null,"abstract":"Background: Seven-day working in hospitals is a current priority of international health research and policy. Previous research has shown variability in delivering evidence-based clinical interventions across different times of the day and week. We aimed to identify factors influencing such variations in London hyperacute stroke units. / \u0000 \u0000Objectives: To investigate variations in quality of acute stroke care and outcomes by day and time of admission in London hyperacute stroke units, and to identify factors influencing such variations. / \u0000 \u0000Design: This was a prospective cohort study using anonymised patient-level data from the Sentinel Stroke National Audit Programme. Factors influencing variations in care and outcomes were studied through interview and observation data. / \u0000 \u0000Setting: The setting was acute stroke services in London hyperacute stroke units. / \u0000 \u0000Participants: A total of 7094 patients with a primary diagnosis of stroke took part. We interviewed hyperacute stroke unit staff (n = 76), including doctors, nurses, therapists and administrators, and 31 patients and carers. We also conducted non-participant observations of delivery of care at different times of the day and week (n = 45, ≈102 hours). / \u0000 \u0000Intervention: Hub-and-spoke model for care of suspected acute stroke patients in London with performance standards was designed to deliver uniform access to high-quality hyperacute stroke unit care across the week. / \u0000 \u0000Main outcome measures: Indicators of quality of acute stroke care, mortality at 3 days after admission, disability at the end of the inpatient spell and length of stay. / \u0000 \u0000Data sources: Sentinel Stroke National Audit Programme data for all patients in London hyperacute stroke units with a primary diagnosis of stroke between 1 January and 31 December 2014, and nurse staffing data for all eight London hyperacute stroke units for the same period. / \u0000 \u0000Results: We found no variation in quality of care by day and time of admission across the week in terms of stroke nursing assessment, brain scanning and thrombolysis in London hyperacute stroke units, nor in 3-day mortality nor disability at hospital discharge. Other quality-of-care measures significantly varied by day and time of admission. Quality of care was better if the nurse in charge was at a higher band and/or there were more nurses on duty. Staff deliver ‘front-door’ interventions consistently by taking on additional responsibilities out of hours, creating continuities between day and night, building trusting relationships and prioritising ‘front-door’ interventions. / \u0000 \u0000Limitations: We were unable to measure long-term outcomes as our request to the Sentinel Stroke National Audit Programme, the Healthcare Quality Improvement Partnership and NHS Digital for Sentinel Stroke National Audit Programme data linked with patient mortality status was not fulfilled. / \u0000 \u0000Conclusions: Organisational factors influence 24 hours a day, 7 days a week (24/7), provision of stroke c","PeriodicalId":12880,"journal":{"name":"Health Services and Delivery Research","volume":"8 1","pages":"1-98"},"PeriodicalIF":0.0,"publicationDate":"2020-09-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"42135793","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}