Health and social care delivery research最新文献

{"title":"Thinking ahead about medical treatments in advanced illness: a qualitative study of barriers and enablers in end-of-life care planning with patients and families from ethnically diverse backgrounds.","authors":"Zoebia Islam,&nbsp;Kristian Pollock,&nbsp;Anne Patterson,&nbsp;Matilda Hanjari,&nbsp;Louise Wallace,&nbsp;Irfhan Mururajani,&nbsp;Simon Conroy,&nbsp;Christina Faull","doi":"10.3310/JVFW4781","DOIUrl":"https://doi.org/10.3310/JVFW4781","url":null,"abstract":"<p><strong>Background: </strong>This study explored whether or not, and how, terminally ill patients from ethnically diverse backgrounds and their family caregivers think ahead about deterioration and dying, and explored their engagement with health-care professionals in end-of-life care planning.</p><p><strong>Objective: </strong>The aim was to address the question, what are the barriers to and enablers of ethnically diverse patients, family caregivers and health-care professionals engaging in end-of-life care planning?</p><p><strong>Design: </strong>This was a qualitative study comprising 18 longitudinal patient-centred case studies, interviews with 19 bereaved family caregivers and 50 public and professional stakeholder responses to the findings.</p><p><strong>Setting: </strong>The study was set in Nottinghamshire and Leicestershire in the UK.</p><p><strong>Results: </strong>Key barriers - the predominant stance of patients was to live with hope, considering the future only in terms of practical matters (wills and funerals), rather than the business of dying. For some, planning ahead was counter to their faith. Health-care professionals seemed to feature little in people's lives. Some participants indicated a lack of trust and experienced a disjointed system, devoid of due regard for them. However, religious and cultural mores were of great importance to many, and there were anxieties about how the system valued and enabled these. Family duty and community expectations were foregrounded in some accounts and concern about being in the (un)care of strangers was common. Key enablers - effective communication with trusted individuals, which enables patients to feel known and that their faith, family and community life are valued. Health-care professionals getting to 'know' the person is key. Stakeholder responses highlighted the need for development of Health-care professionals' confidence, skills and training, Using stories based on the study findings was seen as an effective way to support this. A number of behavioural change techniques were also identified.</p><p><strong>Limitations: </strong>It was attempted to include a broad ethnic diversity in the sample, but the authors acknowledge that not all groups could be included.</p><p><strong>Conclusions: </strong>What constitutes good end-of-life care is influenced by the intersectionality of diverse factors, including beliefs and culture. All people desire personalised, compassionate and holistic end-of-life care, and the current frameworks for good palliative care support this. However, health-care professionals need additional skills to navigate complex, sensitive communication and enquire about aspects of people's lives that may be unfamiliar. The challenge for health-care professionals and services is the delivery of holistic care and the range of skills that are required to do this.</p><p><strong>Future work: </strong>Priorities for future research: How can health professionals identify if/w","PeriodicalId":73204,"journal":{"name":"Health and social care delivery research","volume":"11 7","pages":"1-135"},"PeriodicalIF":0.0,"publicationDate":"2023-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9854601","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":"Towards achieving interorganisational collaboration between health-care providers: a realist evidence synthesis.","authors":"Ross Millar,&nbsp;Justin Avery Aunger,&nbsp;Anne Marie Rafferty,&nbsp;Joanne Greenhalgh,&nbsp;Russell Mannion,&nbsp;Hugh McLeod,&nbsp;Deborah Faulks","doi":"10.3310/KPLT1423","DOIUrl":"https://doi.org/10.3310/KPLT1423","url":null,"abstract":"<p><strong>Background: </strong>Interorganisational collaboration is currently being promoted to improve the performance of NHS providers. However, up to now, there has, to the best of our knowledge, been no systematic attempt to assess the effect of different approaches to collaboration or to understand the mechanisms through which interorganisational collaborations can work in particular contexts.</p><p><strong>Objectives: </strong>Our objectives were to (1) explore the main strands of the literature about interorganisational collaboration and to identify the main theoretical and conceptual frameworks, (2) assess the empirical evidence with regard to how different interorganisational collaborations may (or may not) lead to improved performance and outcomes, (3) understand and learn from NHS evidence users and other stakeholders about how and where interorganisational collaborations can best be used to support turnaround processes, (4) develop a typology of interorganisational collaboration that considers different types and scales of collaboration appropriate to NHS provider contexts and (5) generate evidence-informed practical guidance for NHS providers, policy-makers and others with responsibility for implementing and assessing interorganisational collaboration arrangements.</p><p><strong>Design: </strong>A realist synthesis was carried out to develop, test and refine theories about how interorganisational collaborations work, for whom and in what circumstances.</p><p><strong>Data sources: </strong>Data sources were gathered from peer-reviewed and grey literature, realist interviews with 34 stakeholders and a focus group with patient and public representatives.</p><p><strong>Review methods: </strong>Initial theories and ideas were gathered from scoping reviews that were gleaned and refined through a realist review of the literature. A range of stakeholder interviews and a focus group sought to further refine understandings of what works, for whom and in what circumstances with regard to high-performing interorganisational collaborations.</p><p><strong>Results: </strong>A realist review and synthesis identified key mechanisms, such as trust, faith, confidence and risk tolerance, within the functioning of effective interorganisational collaborations. A stakeholder analysis refined this understanding and, in addition, developed a new programme theory of collaborative performance, with mechanisms related to cultural efficacy, organisational efficiency and technological effectiveness. A series of translatable tools, including a diagnostic survey and a collaboration maturity index, were also developed.</p><p><strong>Limitations: </strong>The breadth of interorganisational collaboration arrangements included made it difficult to make specific recommendations for individual interorganisational collaboration types. The stakeholder analysis focused exclusively on England, UK, where the COVID-19 pandemic posed challenges for fieldwork.</p><p><strong>Con","PeriodicalId":73204,"journal":{"name":"Health and social care delivery research","volume":"11 6","pages":"1-130"},"PeriodicalIF":0.0,"publicationDate":"2023-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9859694","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":"A multimethod study of NHS 111 online.","authors":"Joanne Turnbull,&nbsp;Jennifer MacLellan,&nbsp;Kate Churruca,&nbsp;Louise A Ellis,&nbsp;Jane Prichard,&nbsp;David Browne,&nbsp;Jeffrey Braithwaite,&nbsp;Emily Petter,&nbsp;Matthew Chisambi,&nbsp;Catherine Pope","doi":"10.3310/YTRR9821","DOIUrl":"https://doi.org/10.3310/YTRR9821","url":null,"abstract":"<p><strong>Background: </strong>NHS 111 online offers 24-hour access to health assessment and triage.</p><p><strong>Objectives: </strong>This study examined pathways to care, differential access and use, and workforce impacts of NHS 111 online. This study compared NHS 111 with Healthdirect (Haymarket, Australia) virtual triage.</p><p><strong>Design: </strong>Interviews with 80 staff and stakeholders in English primary, urgent and emergency care, and 41 staff and stakeholders associated with Healthdirect. A survey of 2754 respondents, of whom 1137 (41.3%) had used NHS 111 online and 1617 (58.7%) had not.</p><p><strong>Results: </strong>NHS 111 online is one of several digital health-care technologies and was not differentiated from the NHS 111 telephone service or well understood. There is a similar lack of awareness of Healthdirect virtual triage. NHS 111 and Healthdirect virtual triage are perceived as creating additional work for health-care staff and inappropriate demand for some health services, especially emergency care. One-third of survey respondents reported that they had not used any NHS 111 service (telephone or online). Older people and those with less educational qualifications are less likely to use NHS 111 online. Respondents who had used NHS 111 online reported more use of other urgent care services and make more cumulative use of services than those who had not used NHS 111 online. Users of NHS 111 online had higher levels of self-reported eHealth literacy. There were differences in reported preferences for using NHS 111 online for different symptom presentations.</p><p><strong>Conclusions: </strong>Greater clarity about what the NHS 111 online service offers would allow better signposting and reduce confusion. Generic NHS 111 services are perceived as creating additional work in the primary, urgent and emergency care system. There are differences in eHealth literacy between users and those who have not used NHS 111 online, and this suggests that 'digital first' policies may increase health inequalities.</p><p><strong>Limitations: </strong>This research bridged the pandemic from 2020 to 2021; therefore, findings may change as services adjust going forward. Surveys used a digital platform so there is probably bias towards some level of e-Literacy, but this also means that our data may underestimate the digital divide.</p><p><strong>Future work: </strong>Further investigation of access to digital services could address concerns about digital exclusion. Research comparing the affordances and cost-benefits of different triage and assessment systems for users and health-care providers is needed. Research about trust in virtual assessments may show how duplication can be reduced. Mixed-methods studies looking at outcomes, impacts on work and costs, and ways to measure eHealth literacy, can inform the development NHS 111 online and opportunities for further international shared learning could be pursued.</p><p><strong>Study registration:","PeriodicalId":73204,"journal":{"name":"Health and social care delivery research","volume":"11 5","pages":"1-104"},"PeriodicalIF":0.0,"publicationDate":"2023-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9854602","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 computerised decision support systems on nursing and allied health professional performance and patient outcomes: a systematic review and user contextualisation.","authors":"Carl Thompson,&nbsp;Teumzghi Mebrahtu,&nbsp;Sarah Skyrme,&nbsp;Karen Bloor,&nbsp;Deidre Andre,&nbsp;Anne Maree Keenan,&nbsp;Alison Ledward,&nbsp;Huiqin Yang,&nbsp;Rebecca Randell","doi":"10.3310/GRNM5147","DOIUrl":"https://doi.org/10.3310/GRNM5147","url":null,"abstract":"<p><strong>Background: </strong>Computerised decision support systems (CDSS) are widely used by nurses and allied health professionals but their effect on clinical performance and patient outcomes is uncertain.</p><p><strong>Objectives: </strong>Evaluate the effects of clinical decision support systems use on nurses', midwives' and allied health professionals' performance and patient outcomes and sense-check the results with developers and users.</p><p><strong>Eligibility criteria: </strong>Comparative studies (randomised controlled trials (RCTs), non-randomised trials, controlled before-and-after (CBA) studies, interrupted time series (ITS) and repeated measures studies comparing) of CDSS versus usual care from nurses, midwives or other allied health professionals.</p><p><strong>Information sources: </strong>Nineteen bibliographic databases searched October 2019 and February 2021.</p><p><strong>Risk of bias: </strong>Assessed using structured risk of bias guidelines; almost all included studies were at high risk of bias.</p><p><strong>Synthesis of results: </strong>Heterogeneity between interventions and outcomes necessitated narrative synthesis and grouping by: similarity in focus or CDSS-type, targeted health professionals, patient group, outcomes reported and study design.</p><p><strong>Included studies: </strong>Of 36,106 initial records, 262 studies were assessed for eligibility, with 35 included: 28 RCTs (80%), 3 CBA studies (8.6%), 3 ITS (8.6%) and 1 non-randomised trial, a total of 1318 health professionals and 67,595 patient participants. Few studies were multi-site and most focused on decision-making by nurses (71%) or paramedics (5.7%). Standalone, computer-based CDSS featured in 88.7% of the studies; only 8.6% of the studies involved 'smart' mobile or handheld technology. Care processes - including adherence to guidance - were positively influenced in 47% of the measures adopted. For example, nurses' adherence to hand disinfection guidance, insulin dosing, on-time blood sampling, and documenting care were improved if they used CDSS. Patient care outcomes were statistically - if not always clinically - significantly improved in 40.7% of indicators. For example, lower numbers of falls and pressure ulcers, better glycaemic control, screening of malnutrition and obesity, and accurate triaging were features of professionals using CDSS compared to those who were not.</p><p><strong>Evidence limitations: </strong>Allied health professionals (AHPs) were underrepresented compared to nurses; systems, studies and outcomes were heterogeneous, preventing statistical aggregation; very wide confidence intervals around effects meant clinical significance was questionable; decision and implementation theory that would have helped interpret effects - including null effects - was largely absent; economic data were scant and diverse, preventing estimation of overall cost-effectiveness.</p><p><strong>Interpretation: </strong>CDSS can positively influence ","PeriodicalId":73204,"journal":{"name":"Health and social care delivery research","volume":" ","pages":"1-85"},"PeriodicalIF":0.0,"publicationDate":"2023-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9835191","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":"Factors which facilitate or impede patient engagement with pulmonary and cardiac rehabilitation: a rapid evaluation mapping review.","authors":"Lindsay Blank,&nbsp;Anna Cantrell,&nbsp;Katie Sworn,&nbsp;Andrew Booth","doi":"10.3310/KLWR9463","DOIUrl":"https://doi.org/10.3310/KLWR9463","url":null,"abstract":"<p><strong>Background: </strong>There is a considerable body of systematic review evidence considering the effectiveness of rehabilitation programmes on clinical outcomes. However, much less is known about effectively engaging and sustaining patients in rehabilitation. There is a need to understand the full range of potential intervention strategies.</p><p><strong>Methods: </strong>We conducted a mapping review of UK review-level evidence published 2017-21. We searched MEDLINE, EMBASE and the Cumulative Index to Nursing and Allied Health (CINAHL) and conducted a narrative synthesis. Included reviews reported factors affecting commencement, continuation or completion of cardiac or pulmonary rehabilitation, or an intervention to facilitate these factors. Study selection was undertaken independently by two reviewers.</p><p><strong>Results: </strong>In total, we identified 20 review papers that met our inclusion criteria. There was a bias towards reviews considering cardiac rehabilitation, with these numbering 16. An additional 11 unpublished interventions were also identified through internet searching of key websites. The reviews included 60 identifiable UK primary studies that considered factors which affected attendance at rehabilitation; 42 considered cardiac rehabilitation and 18 considering pulmonary rehabilitation. They reported on factors from the patients' point of view, as well as the views of professionals involved in referral or treatment. It was more common for factors to be reported as impeding attendance at rehabilitation rather than facilitating it. We grouped the factors into patient perspective (support, culture, demographics, practical, health, emotions, knowledge/beliefs and service factors) and professional perspective (knowledge: staff and patient, staffing, adequacy of service provision and referral from other services, including support and wait times). We found considerably fewer reviews (<i>n</i> = 3) looking at interventions to facilitate participation in rehabilitation. Although most of the factors affecting participation were reported from a patient perspective, most of the identified interventions were implemented to address barriers to access in terms of the provider perspective. The majority of access challenges identified by patients would not therefore be addressed by the identified interventions. The more recent unevaluated interventions implemented during the COVID-19 pandemic may have the potential to act on some of the patient barriers in access to services, including travel and inconvenient timing of services.</p><p><strong>Conclusions: </strong>The factors affecting commencement, continuation or completion of cardiac or pulmonary rehabilitation consist of a web of complex and interlinked factors taking into consideration the perspectives of the patients and the service providers. The small number of published interventions we identified that aim to improve access are unlikely to address the majority of these f","PeriodicalId":73204,"journal":{"name":"Health and social care delivery research","volume":"11 4","pages":"1-59"},"PeriodicalIF":0.0,"publicationDate":"2023-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9854604","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":"Mental health crisis care for children and young people aged 5 to 25 years: the CAMH-Crisis evidence synthesis","authors":"N. Evans, D. Edwards, Judith Carrier, Mair Elliott, Elizabeth Gillen, B. Hannigan, Rhiannon Lane, Liz Williams","doi":"10.3310/bppt3407","DOIUrl":"https://doi.org/10.3310/bppt3407","url":null,"abstract":"\u0000Mental health care for children and young people is a rising concern, with one in six children aged 5–19 years in England having a probable diagnosable mental disorder. Care for children and young people in crisis is known to be delivered by multiple agencies using a range of approaches.\u0000\u0000\u0000The review objectives of this study were to critically appraise, synthesise and present the best-available international evidence related to crisis services for children and young people aged 5–25 years, specifically looking at the organisation of crisis services across education, health, social care and the third sector, and the experiences and perceptions of young people, families and staff, to determine the effectiveness of current models and the goals of crisis intervention.\u0000\u0000\u0000All relevant English-language international evidence specifically relating to the provision and receipt of crisis support for children and young people aged 5–25 years, from January 1995 to January 2021, was sought. Comprehensive searches were conducted across 17 databases and supplementary searching was undertaken to identify grey literature. Two team members appraised all the retrieved research reports (except grey literature) using critical appraisal checklists. A separate analysis was conducted for each objective. Confidence in research findings was assessed using the Grading of Recommendations Assessment, Development and Evaluation and the Confidence in the Evidence from Reviews of Qualitative research approaches.\u0000\u0000\u0000One hundred and thirty-eight reports were used to inform this evidence synthesis, including 39 descriptive accounts of the organisation of crisis services (across 36 reports), 42 research studies (across 48 reports) and 54 grey literature documents. The organisation of crisis services has been categorised as follows: triage/assessment only, digitally mediated support approaches, and intervention approaches and models. When looking at experiences of crisis care, the following four themes were identified: (1) barriers to and facilitators of seeking and accessing appropriate support; (2) what children and young people want from crisis services; (3) children’s, young people’s and families’ experiences of crisis services; and (4) service provision. In determining effectiveness, the findings are summarised by type of service and were generated from single heterogenous studies. The goals of a crisis service should be to (1) keep children and young people in their home environment as an alternative to admission; (2) assess need and plan; (3) improve children’s and young people’s and/or their families’ engagement with community treatment; (4) link children and young people and/or their families to additional mental health services, as necessary; (5) provide peer support; (6) stabilise and manage the present crisis over the immediate period; and (7) train and/or supervise staff. The key limitation of this review was that much of the literature was drawn from the USA. Owing to ","PeriodicalId":73204,"journal":{"name":"Health and social care delivery research","volume":"1 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"46340503","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":"Centralisation of specialist cancer surgery services in two areas of England: the RESPECT-21 mixed-methods evaluation","authors":"Naomi J. Fulop, A. Ramsay, C. Vindrola‐Padros, C. Clarke, R. Hunter, G. Black, Victoria J Wood, M. Melnychuk, C. Perry, L. Vallejo-Torres, P. L. Ng, R. Barod, A. Bex, R. Boaden, Afsana Bhuiya, Veronica Brinton, P. Fahy, J. Hines, C. Levermore, S. Maddineni, Muntzer M. Mughal, K. Pritchard-Jones, J. Sandell, D. Shackley, M. Tran, Steve Morris","doi":"10.3310/qfgt2379","DOIUrl":"https://doi.org/10.3310/qfgt2379","url":null,"abstract":"\u0000 \u0000 Centralising specialist cancer surgical services is an example of major system change. High-volume centres are recommended to improve specialist cancer surgery care and outcomes.\u0000 \u0000 \u0000 \u0000 Our aim was to use a mixed-methods approach to evaluate the centralisation of specialist surgery for prostate, bladder, renal and oesophago-gastric cancers in two areas of England [i.e. London Cancer (London, UK), which covers north-central London, north-east London and west Essex, and Greater Manchester Cancer (Manchester, UK), which covers Greater Manchester].\u0000 \u0000 \u0000 \u0000 Stakeholder preferences for centralising specialist cancer surgery were analysed using a discrete choice experiment, surveying cancer patients (n = 206), health-care professionals (n = 111) and the general public (n = 127). Quantitative analysis of impact on care, outcomes and cost-effectiveness used a controlled before-and-after design. Qualitative analysis of implementation and outcomes of change used a multisite case study design, analysing documents (n = 873), interviews (n = 212) and non-participant observations (n = 182). To understand how lessons apply in other contexts, we conducted an online workshop with stakeholders from a range of settings. A theory-based framework was used to synthesise these approaches.\u0000 \u0000 \u0000 \u0000 \u0000 Stakeholder preferences – patients, health-care professionals and the public had similar preferences, prioritising reduced risk of complications and death, and better access to specialist teams. Travel time was considered least important. Quantitative analysis (impact of change) – only London Cancer’s centralisations happened soon enough for analysis. These changes were associated with fewer surgeons doing more operations and reduced length of stay [prostate –0.44 (95% confidence interval –0.55 to –0.34) days; bladder –0.563 (95% confidence interval –4.30 to –0.83) days; renal –1.20 (95% confidence interval –1.57 to –0.82) days]. The centralisation meant that renal patients had an increased probability of receiving non-invasive surgery (0.05, 95% confidence interval 0.02 to 0.08). We found no evidence of impact on mortality or re-admissions, possibly because risk was already low pre-centralisation. London Cancer’s prostate, oesophago-gastric and bladder centralisations had medium probabilities (79%, 62% and 49%, respectively) of being cost-effective, and centralising renal services was not cost-effective (12% probability), at the £30,000/quality-adjusted life-year threshold. Qualitative analysis, implementation and outcomes – London Cancer’s provider-led network overcame local resistance by distributing leadership throughout the system. Important facilitators included consistent clinical leadership and transparent governance processes. Greater Manchester Cancer’s change leaders learned from history to deliver the oesophago-gastric centralisation. Greater Manchester Cancer’s urology centralisations were not implemented because of local concerns about the service model and lo","PeriodicalId":73204,"journal":{"name":"Health and social care delivery research","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"48772513","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":"Clinical effectiveness and cost-effectiveness of emergency surgery for adult emergency hospital admissions with common acute gastrointestinal conditions: the ESORT study","authors":"Richard Grieve, Andrew Hutchings, Silvia Moler Zapata, Stephen O’Neill, David G Lugo-Palacios, Richard Silverwood, David Cromwell, Tommaso Kircheis, Elizabeth Silver, Claire Snowdon, Paul Charlton, Geoff Bellingan, Ramani Moonesinghe, Luke Keele, Neil Smart, Robert Hinchliffe","doi":"10.3310/czfl0619","DOIUrl":"https://doi.org/10.3310/czfl0619","url":null,"abstract":"Background Evidence is required on the clinical effectiveness and cost-effectiveness of emergency surgery compared with non-emergency surgery strategies (including medical management, non-surgical procedures and elective surgery) for patients admitted to hospital with common acute gastrointestinal conditions. Objectives We aimed to evaluate the relative (1) clinical effectiveness of two strategies (i.e. emergency surgery vs. non-emergency surgery strategies) for five common acute conditions presenting as emergency admissions; (2) cost-effectiveness for five common acute conditions presenting as emergency admissions; and (3) clinical effectiveness and cost-effectiveness of the alternative strategies for specific patient subgroups. Methods The records of adults admitted as emergencies with acute appendicitis, cholelithiasis, diverticular disease, abdominal wall hernia or intestinal obstruction to 175 acute hospitals in England between 1 April 2010 and 31 December 2019 were extracted from Hospital Episode Statistics and linked to mortality data from the Office for National Statistics. Eligibility was determined using International Statistical Classification of Diseases and Related Health Problems , Tenth Revision, diagnosis codes, which were agreed by clinical panel consensus. Patients having emergency surgery were identified from Office of Population Censuses and Surveys procedure codes. The study addressed the potential for unmeasured confounding with an instrumental variable design. The instrumental variable was each hospital’s propensity to use emergency surgery compared with non-emergency surgery strategies. The primary outcome was the ‘number of days alive and out of hospital’ at 90 days. We reported the relative effectiveness of the alternative strategies overall, and for prespecified subgroups (i.e. age, number of comorbidities and frailty level). The cost-effectiveness analyses used resource use and mortality from the linked data to derive estimates of incremental costs, quality-adjusted life-years and incremental net monetary benefits at 1 year. Results Cohort sizes were as follows: 268,144 admissions with appendicitis, 240,977 admissions with cholelithiasis, 138,869 admissions with diverticular disease, 106,432 admissions with a hernia and 133,073 admissions with an intestinal obstruction. Overall, at 1 year, the average number of days alive and out of hospitals at 90 days, costs and quality-adjusted life-years were similar following either strategy, after adjusting for confounding. For each of the five conditions, overall, the 95% confidence intervals (CIs) around the incremental net monetary benefit estimates all included zero. For patients with severe frailty, emergency surgery led to a reduced number of days alive and out of hospital and was not cost-effective compared with non-emergency surgery, with incremental net monetary benefit estimates of –£18,727 (95% CI –£23,900 to –£13,600) for appendicitis, –£7700 (95% CI –£13,000 to –£237","PeriodicalId":73204,"journal":{"name":"Health and social care delivery research","volume":"16 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135470811","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":"Health literacy interventions for reducing the use of primary and emergency services for minor health problems: a systematic review","authors":"A. O’Cathain, Alexis Foster, Chris Carroll, L. Preston, M. Ogden, M. Clowes, J. Protheroe","doi":"10.3310/ivqj9044","DOIUrl":"https://doi.org/10.3310/ivqj9044","url":null,"abstract":"\u0000 \u0000 Health literacy is the ability to find information, understand information, know how to act on information and know which services to use. Having higher levels of health literacy may help patients to look after minor problems themselves (self-care). It may also help to reduce patients’ perceived need for contacting health services for minor health problems, to reduce the perceived urgency of problems or to improve patients’ ability to identify and choose from the range of available services. Interventions to improve health literacy for minor health problems have been evaluated, but their effectiveness at reducing use of primary care and emergency services has not been synthesised.\u0000 \u0000 \u0000 \u0000 The key objectives were as follows: (1) to construct a typology of interventions that aim to reduce primary or emergency care use, (2) to synthesise evidence of the effectiveness of different types of health literacy interventions and (3) to consider how stakeholders in the UK could operationalise the evidence.\u0000 \u0000 \u0000 \u0000 The interventions being reviewed were initiatives that help members of the population to self-care or make decisions about whether or not and where to seek health care for minor health problems.\u0000 \u0000 \u0000 \u0000 This study was a systematic review with stakeholder involvement.\u0000 \u0000 \u0000 \u0000 A meeting was held with 14 stakeholders (including patients, carers and the public) to guide the systematic review. This was followed by a multicomponent review of quantitative and qualitative research. Database literature searches were undertaken in Ovid MEDLINE, The Cochrane Library (via Wiley Interscience), EMBASE (via OVID), the Cumulative Index to Nursing and Allied Health Literature (via EBSCO), PsycINFO (via OVID), Web of Science and Sociological Abstracts. The search was limited to English-language publications from 1990–2020. To assess study quality, the Cochrane Risk of Bias tool was used for randomised controlled trials and the Newcastle–Ottawa Scale was used for non-randomised studies. A narrative synthesis was undertaken. The review was followed by a meeting with 16 stakeholders to interpret the results.\u0000 \u0000 \u0000 \u0000 A total of 67 articles (64 studies) were included: 37 from the USA, 16 from the UK, 12 from the rest of Europe and two from the rest of the world. There were seven intervention types: navigation tools directing people to the range of services available (n = 7); written education about managing minor health problems in booklet or website format (n = 17); person-delivered education (n = 5); written education with person-delivered education (n = 17); multicomponent of written education, person-delivered education and mass media campaign (n = 5); self-triage (n = 9); and other (n = 7). Our team assessed the readability and user-friendliness of interventions, and found that these varied widely. When assessed, most studies measuring satisfaction with the intervention, enablement and perceived changes to behaviour showed positive results. Of 30 articles reporting ","PeriodicalId":73204,"journal":{"name":"Health and social care delivery research","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"45666842","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":"Improving risk prediction model quality in the critically ill: data linkage study","authors":"P. Ferrando-Vivas, M. Shankar-Hari, K. Thomas, J. Doidge, F. Caskey, L. Forni, S. Harris, M. Ostermann, I. Gornik, N. Holman, N. Lone, B. Young, D. Jenkins, S. Webb, J. Nolan, J. Soar, K. Rowan, D. Harrison","doi":"10.3310/eqab4594","DOIUrl":"https://doi.org/10.3310/eqab4594","url":null,"abstract":"\u0000 \u0000 A previous National Institute for Health and Care Research study [Harrison DA, Ferrando-Vivas P, Shahin J, Rowan KM. Ensuring comparisons of health-care providers are fair: development and validation of risk prediction models for critically ill patients. Health Serv Deliv Res 2015;3(41)] identified the need for more research to understand risk factors and consequences of critical care and subsequent outcomes.\u0000 \u0000 \u0000 \u0000 First, to improve risk models for adult general critical care by developing models for mortality at fixed time points and time-to-event outcomes, end-stage renal disease, type 2 diabetes, health-care utilisation and costs. Second, to improve risk models for cardiothoracic critical care by enhancing risk factor data and developing models for longer-term mortality. Third, to improve risk models for in-hospital cardiac arrest by enhancing risk factor data and developing models for longer-term mortality and critical care utilisation.\u0000 \u0000 \u0000 \u0000 Risk modelling study linking existing data.\u0000 \u0000 \u0000 \u0000 NHS adult critical care units and acute hospitals in England.\u0000 \u0000 \u0000 \u0000 Patients admitted to an adult critical care unit or experiencing an in-hospital cardiac arrest.\u0000 \u0000 \u0000 \u0000 None.\u0000 \u0000 \u0000 \u0000 Mortality at hospital discharge, 30 days, 90 days and 1 year following critical care unit admission; mortality at 1 year following discharge from acute hospital; new diagnosis of end-stage renal disease or type 2 diabetes; hospital resource use and costs; return of spontaneous circulation sustained for > 20 minutes; survival to hospital discharge and 1 year; and length of stay in critical care following in-hospital cardiac arrest.\u0000 \u0000 \u0000 \u0000 Case Mix Programme, National Cardiac Arrest Audit, UK Renal Registry, National Diabetes Audit, National Adult Cardiac Surgery Audit, Hospital Episode Statistics and Office for National Statistics.\u0000 \u0000 \u0000 \u0000 Data were linked for 965,576 critical care admissions between 1 April 2009 and 31 March 2016, and 83,939 in-hospital cardiac arrests between 1 April 2011 and 31 March 2016. For admissions to adult critical care units, models for 30-day mortality had similar predictors and performance to those for hospital mortality and did not reduce heterogeneity. Models for longer-term outcomes reflected increasing importance of chronic over acute predictors. New models for end-stage renal disease and diabetes will allow benchmarking of critical care units against these important outcomes and identification of patients requiring enhanced follow-up. The strongest predictors of health-care costs were prior hospitalisation, prior dependency and chronic conditions. Adding pre- and intra-operative risk factors to models for cardiothoracic critical care gave little improvement in performance. Adding comorbidities to models for in-hospital cardiac arrest provided modest improvements but were of greater importance for longer-term outcomes.\u0000 \u0000 \u0000 \u0000 Delays in obtaining linked data resulted in the data used being 5 years old at the point of publication: models","PeriodicalId":73204,"journal":{"name":"Health and social care delivery research","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"46830910","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}