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Showing posts from August, 2013

Managing routinely collected NHS data for research

Health research using routinely collected National Health Service (NHS) data derived from electronic health records (EHRs) and health service information systems has been growing in both importance and quantity. Wide population coverage and detailed patient-level information allow this data to be applied to a variety of research questions.

The sensitivity, complexity and scale of such data also hamper researchers from fully exploiting this potential. In an article published in the journal Informatics in Primary Care, Vasa Curcin and colleagues examine the current challenges preventing researchers from making optimal use of the data sets at their disposal, on both the legislative and practical levels, and give recommendations as to how these challenges can be overcome.

Several projects have recently been launched in the UK to address poor research data-management practices. Rapid Organisation of Healthcare Research Data (ROHRD) at Imperial College, London produced a useful prototype t…

Primary care and population factors associated with NHS Health Check coverage

High and equitable coverage of systematic cardiovascular disease (CVD) prevention programmes, such as the NHS Health Check programme in England, is essential if they are to effectively reduce the population CVD burden. In a paper published in the Journal of Public Health, Macide Artac report the findings of a cross-sectional study using data from 151 English primary care trusts (PCTs) on NHS Health Check coverage during 2011–12. They examined the associations between programme coverage and primary care and population factors, including patient demographics, primary care workforce and cardiovascular health need.

Artac and colleagues reported that the median coverage of NHS Health Checks was 8.2%, with wide PCT-level variation (range = 0–29.8%). Coverage was significantly higher in PCTs in the most deprived areas compared with the least deprived, after adjusting for covariates. Significant negative associations between coverage and a higher proportion of PCT population aged 40–74 years…

Admission rates for heart failure in England 2004–2011

Heart failure is an important clinical problem. Expert consensus has defined heart failure as a primary care-sensitive condition for which the risk of unplanned admissions may be reduced by high quality primary care, but there is little supporting evidence. In a paper published in the European Journal of Heart Failure, Rachel Brettell and colleagues analysed time trends in Heart failure admission rates in England and risk and protective factors for admission.

They used Hospital Episodes Statistics to produce indirectly standardized HF admission counts by general practice for 2004–2011. Clustered negative binomial regression analysis produced admission risk ratios and assessed the significance of potential explanatory covariates. These included population factors (deprivation; HF, coronary heart disease, and smoking prevalence), primary care resourcing [access; general practitioner (GP) supply], and primary care quality (‘Quality and Outcomes Framework’ indicator.) There were 327,756 …

A mixed methods evaluation of the Integrated Care Pilot in North-West London

The North-West London Integrated Care Pilot (ICP), originally launched for one year in July 2011 and later extended for a further year, is a large-scale change programme involving two hospitals, two mental health providers, three community health care service providers, five municipal providers of social care, two non-governmental organisations and (by April 2012) 103 general practitioners. Its aims are to improve health outcomes and reduce unnecessary admissions to hospital by pro-actively managing people living with diabetes and/or those aged 75+ through creating better access to more integrated care outside hospital and by enabling effective working of professionals across organisations.  In a paper published in the International Journal of Integrated Care, researchers from Imperial College London and the Nuffield Trust describe the results of the evaluation of the first year of the programme. The evaluation was funded by the Imperial College Healthcare NHS Trust Charity and the N…