Angus Ig Ramsay, Kevin Herbert, Rachel Lawrence, Chris Sherlaw-Johnson, Stuti Bagri, Nadia Crellin, Emma Dodsworth, Holly Elphinstone, Amanda Halliday, Joanne Lloyd, Efthalia Massou, Raj Mehta, Stephen Morris, Pei Li Ng, Holly Walton, Naomi J Fulop
<p><strong>Background: </strong>Artificial intelligence tools simulate aspects of human intelligence. Policy and research highlight artificial intelligence's potential to support delivery of radiology pathways. In 2023, National Health Service (NHS) England invested £21M to deploy artificial intelligence diagnostic tools for chest X-ray and chest computed tomography in 66 NHS Trusts. Little is known about how artificial intelligence tools are implemented in practice, staff experience of these tools, and their effectiveness and cost.</p><p><strong>Objectives: </strong>Evaluate evidence on artificial intelligence tools within radiology internationally. Evaluate implementation of artificial intelligence for chest diagnostics in England. Investigate how effectiveness and cost-effectiveness of artificial intelligence for chest diagnostics can be measured.</p><p><strong>Methods: </strong>Ten-month mixed-methods study (rapid scoping review and empirical study comprising staff interviews, observations and documentary analysis). Findings were analysed using rapid assessment procedures, drawing on qualitative, quantitative and health economic approaches. Our evaluation was also designed to inform phase 2 of our study.</p><p><strong>Findings: </strong>The review included 114 articles on artificial intelligence use in radiology, internationally. Empirical work included 51 staff interviews, 57 observations and 166 documents from 10/11 of the networks and 6/66 trusts implementing artificial intelligence tools. Our review found evidence gaps, including real-world implementation of artificial intelligence tools; patient and carer experiences; impact on inequalities, sustainability and wider systems; and cost-effectiveness. Artificial intelligence for chest diagnostics was implemented in various ways, with different aims, pathways and approaches. Implementation takes time due to multiple activities related to planning, procurement, preparation for deployment, monitoring and evaluation. These tasks - technical and social - required time and resource, including a wide range of stakeholders and expertise. As of November 2024, 24/66 trusts had implemented artificial intelligence tools in practice. Implementation barriers included time, resources, challenges navigating processes and adapting these to local contexts. Facilitators included stakeholder engagement and support. Network and trust ability to evaluate service impact was influenced by factors such as data availability, data linkage, resources and capacity. Factors varied across implementation stages. Our findings indicated multiple data sources that may support measurement of effectiveness and cost-effectiveness within the English National Health Service. However, limitations to data availability need to be addressed.</p><p><strong>Limitations: </strong>Our rapid timeline meant we could not interview patients, carers, and several staff groups at trust and national levels. Delayed deployment meant we could not
{"title":"Implementing artificial intelligence in chest diagnostics for lung disease: A mixed-methods evaluation.","authors":"Angus Ig Ramsay, Kevin Herbert, Rachel Lawrence, Chris Sherlaw-Johnson, Stuti Bagri, Nadia Crellin, Emma Dodsworth, Holly Elphinstone, Amanda Halliday, Joanne Lloyd, Efthalia Massou, Raj Mehta, Stephen Morris, Pei Li Ng, Holly Walton, Naomi J Fulop","doi":"10.3310/GJAR2722","DOIUrl":"https://doi.org/10.3310/GJAR2722","url":null,"abstract":"<p><strong>Background: </strong>Artificial intelligence tools simulate aspects of human intelligence. Policy and research highlight artificial intelligence's potential to support delivery of radiology pathways. In 2023, National Health Service (NHS) England invested £21M to deploy artificial intelligence diagnostic tools for chest X-ray and chest computed tomography in 66 NHS Trusts. Little is known about how artificial intelligence tools are implemented in practice, staff experience of these tools, and their effectiveness and cost.</p><p><strong>Objectives: </strong>Evaluate evidence on artificial intelligence tools within radiology internationally. Evaluate implementation of artificial intelligence for chest diagnostics in England. Investigate how effectiveness and cost-effectiveness of artificial intelligence for chest diagnostics can be measured.</p><p><strong>Methods: </strong>Ten-month mixed-methods study (rapid scoping review and empirical study comprising staff interviews, observations and documentary analysis). Findings were analysed using rapid assessment procedures, drawing on qualitative, quantitative and health economic approaches. Our evaluation was also designed to inform phase 2 of our study.</p><p><strong>Findings: </strong>The review included 114 articles on artificial intelligence use in radiology, internationally. Empirical work included 51 staff interviews, 57 observations and 166 documents from 10/11 of the networks and 6/66 trusts implementing artificial intelligence tools. Our review found evidence gaps, including real-world implementation of artificial intelligence tools; patient and carer experiences; impact on inequalities, sustainability and wider systems; and cost-effectiveness. Artificial intelligence for chest diagnostics was implemented in various ways, with different aims, pathways and approaches. Implementation takes time due to multiple activities related to planning, procurement, preparation for deployment, monitoring and evaluation. These tasks - technical and social - required time and resource, including a wide range of stakeholders and expertise. As of November 2024, 24/66 trusts had implemented artificial intelligence tools in practice. Implementation barriers included time, resources, challenges navigating processes and adapting these to local contexts. Facilitators included stakeholder engagement and support. Network and trust ability to evaluate service impact was influenced by factors such as data availability, data linkage, resources and capacity. Factors varied across implementation stages. Our findings indicated multiple data sources that may support measurement of effectiveness and cost-effectiveness within the English National Health Service. However, limitations to data availability need to be addressed.</p><p><strong>Limitations: </strong>Our rapid timeline meant we could not interview patients, carers, and several staff groups at trust and national levels. Delayed deployment meant we could not ","PeriodicalId":519880,"journal":{"name":"Health and social care delivery research","volume":" ","pages":"1-42"},"PeriodicalIF":0.0,"publicationDate":"2026-03-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147501058","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}
Katherine Runswick-Cole, Sara Ryan, Martina Smith, Chris Hatton, Patty Douglas, Clare Kassa, Rosemary Cisneros, Liz Croot
<p><strong>Background: </strong>This research addresses the mental health of family carers of adults with learning disabilities. We investigated participants' perceptions of their mental health and views on the accessibility and quality of support.</p><p><strong>Design and methods: </strong>The research involved seven work packages which included public involvement, a rapid scoping review of evidence about family carers' mental health and support, an online exhibition, interviews with parent and sibling carers, digital storytelling workshops, key stakeholder discussions and the creation of learning and teaching materials.</p><p><strong>Results: </strong>Caregiving driven by love is often exploited by health and social care services which deny basic support, information and kindness. Enduring struggle for support and worries about the future are often the cause of mental distress. Participants know what supports mental well-being but have little time to look after themselves due to the lack of support. Social services were described as 'hostile' or absent and participants viewed themselves as exhausted by the lack of support, rather than depressed. Medication can help but can be offered without consideration of their caring role or because there are no alternatives. Participants ask for their statutory entitlements for health and social care support to be met with kindness.</p><p><strong>Outputs and dissemination: </strong>We delivered: (1) an expansive public engagement model; (2) an innovative and creative participatory approach to generate stories of care; (3) a dissemination strategy to raise awareness of the mental health of family carers and (4) the development of general practitioner resources. We published journal articles, blogs, magazine articles, an online exhibition, films and presented findings at international conferences.</p><p><strong>Public and stakeholder involvement and engagement: </strong>Family carers and people with learning disabilities were involved across the study, and in the Study Steering Group.</p><p><strong>Limitations: </strong>Recruitment was slower than expected. Carers were unable to use care replacement costs because of a lack of alternative care. There were challenges involving marginalised communities. We engaged with fewer respondents through the Exhibition than the planned survey; however, it was important to respond to participants' views.</p><p><strong>Conclusions: </strong>Health and care services often fail to recognise or adjust support for family carers despite provision under the Equality Act. The role of love in caring relationships, the absence of consideration of this in research, and the exploitation of this love by service systems which rely heavily on family carers were highlighted. Provisions in The Care Act and The Equalities Act are not always upheld, family carers struggle to gain support over years and even the 'feeblest' acts of kindness make a difference in health and care delivery. There
{"title":"'Tired of spinning plates': Synopsis of mixed methods exploration of mental health experiences of adult/older carers of adults with learning disabilities.","authors":"Katherine Runswick-Cole, Sara Ryan, Martina Smith, Chris Hatton, Patty Douglas, Clare Kassa, Rosemary Cisneros, Liz Croot","doi":"10.3310/GJKR4724","DOIUrl":"https://doi.org/10.3310/GJKR4724","url":null,"abstract":"<p><strong>Background: </strong>This research addresses the mental health of family carers of adults with learning disabilities. We investigated participants' perceptions of their mental health and views on the accessibility and quality of support.</p><p><strong>Design and methods: </strong>The research involved seven work packages which included public involvement, a rapid scoping review of evidence about family carers' mental health and support, an online exhibition, interviews with parent and sibling carers, digital storytelling workshops, key stakeholder discussions and the creation of learning and teaching materials.</p><p><strong>Results: </strong>Caregiving driven by love is often exploited by health and social care services which deny basic support, information and kindness. Enduring struggle for support and worries about the future are often the cause of mental distress. Participants know what supports mental well-being but have little time to look after themselves due to the lack of support. Social services were described as 'hostile' or absent and participants viewed themselves as exhausted by the lack of support, rather than depressed. Medication can help but can be offered without consideration of their caring role or because there are no alternatives. Participants ask for their statutory entitlements for health and social care support to be met with kindness.</p><p><strong>Outputs and dissemination: </strong>We delivered: (1) an expansive public engagement model; (2) an innovative and creative participatory approach to generate stories of care; (3) a dissemination strategy to raise awareness of the mental health of family carers and (4) the development of general practitioner resources. We published journal articles, blogs, magazine articles, an online exhibition, films and presented findings at international conferences.</p><p><strong>Public and stakeholder involvement and engagement: </strong>Family carers and people with learning disabilities were involved across the study, and in the Study Steering Group.</p><p><strong>Limitations: </strong>Recruitment was slower than expected. Carers were unable to use care replacement costs because of a lack of alternative care. There were challenges involving marginalised communities. We engaged with fewer respondents through the Exhibition than the planned survey; however, it was important to respond to participants' views.</p><p><strong>Conclusions: </strong>Health and care services often fail to recognise or adjust support for family carers despite provision under the Equality Act. The role of love in caring relationships, the absence of consideration of this in research, and the exploitation of this love by service systems which rely heavily on family carers were highlighted. Provisions in The Care Act and The Equalities Act are not always upheld, family carers struggle to gain support over years and even the 'feeblest' acts of kindness make a difference in health and care delivery. There","PeriodicalId":519880,"journal":{"name":"Health and social care delivery research","volume":"14 6","pages":"1-35"},"PeriodicalIF":0.0,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147391976","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}
Andy Northcott, Shadreck Mwale, Megan Wyatt, Lucy Series, Karen Harrison Dening, Katie Featherstone
<p><strong>Background: </strong>Inquiries, National Health Service serious incident reviews and media reports identify people living with dementia at significant risk of experiencing restrictive practices during an unscheduled acute hospital admission. However, to date, this has not been the true focus of substantive empirical research.</p><p><strong>Objectives: </strong>To explore the use of restrictive practices in the care of people living with dementia during an unscheduled acute hospital admission. To identify evidence-based (and alternative) strategies in the care of people living with dementia that are achievable, safe and transferrable.</p><p><strong>Design: </strong>An ethnographic study (observation, ethnographic interviews, documentary analysis) in the symbolic interactionist research tradition, with the goal to deliver an in-depth empirically driven analysis of everyday acute care.</p><p><strong>Setting: </strong>This ethnography was carried out for 225 days over an 18-month period between 2023 and 2024. In total, nine wards were observed across six National Health Service trusts in England, covering six acute wards (assessment and older peoples care) and three mental health wards (specialist older people mental health). Sites were chosen for diversity of demographic, geographic and practice variables.</p><p><strong>Participants: </strong>One hundred and sixty-eight individuals consented to participate directly in this study, also contributing to 1116 ethnographic interviews.</p><p><strong>Results: </strong>Our analysis identified a culture of containment within acute wards. The use of restrictive practice in the care of people living with dementia was an embedded aspect of routine ward care, within all shifts observed within acute wards, regardless of the ward, time of day and day of the week. Raised bedside rails, ward furniture and verbal commands were most frequently used, often quickly escalating to the use of enhanced observation, typically carried out at pace, to contain and restrict movement to the bedside. Recordable methods included the use of physical force and sedation. Our analysis demonstrates these apparently diverse range of practices cannot be understood in isolation but were utilised multiply in the care of individuals and cohorts of people living with dementia. Because their use was embedded within timetabled care, ward staff found defining and identifying restrictive interventions in their routine practices challenging, meaning these forms of restrictive practices were typically unrecognised and unrecorded. Staff experienced significant emotional impacts from using restrictive practices in patient care. We identified a range of practices to support the reduction of restrictive practice within the acute setting. These included engagement with people living with dementia, making full use of the activity resources available to the ward, and supporting people living with dementia to leave the bedside to walk within the
{"title":"The use of restrictive practices in the everyday care of people living with dementia in hospital settings: an ethnographic study.","authors":"Andy Northcott, Shadreck Mwale, Megan Wyatt, Lucy Series, Karen Harrison Dening, Katie Featherstone","doi":"10.3310/GJKF0714","DOIUrl":"https://doi.org/10.3310/GJKF0714","url":null,"abstract":"<p><strong>Background: </strong>Inquiries, National Health Service serious incident reviews and media reports identify people living with dementia at significant risk of experiencing restrictive practices during an unscheduled acute hospital admission. However, to date, this has not been the true focus of substantive empirical research.</p><p><strong>Objectives: </strong>To explore the use of restrictive practices in the care of people living with dementia during an unscheduled acute hospital admission. To identify evidence-based (and alternative) strategies in the care of people living with dementia that are achievable, safe and transferrable.</p><p><strong>Design: </strong>An ethnographic study (observation, ethnographic interviews, documentary analysis) in the symbolic interactionist research tradition, with the goal to deliver an in-depth empirically driven analysis of everyday acute care.</p><p><strong>Setting: </strong>This ethnography was carried out for 225 days over an 18-month period between 2023 and 2024. In total, nine wards were observed across six National Health Service trusts in England, covering six acute wards (assessment and older peoples care) and three mental health wards (specialist older people mental health). Sites were chosen for diversity of demographic, geographic and practice variables.</p><p><strong>Participants: </strong>One hundred and sixty-eight individuals consented to participate directly in this study, also contributing to 1116 ethnographic interviews.</p><p><strong>Results: </strong>Our analysis identified a culture of containment within acute wards. The use of restrictive practice in the care of people living with dementia was an embedded aspect of routine ward care, within all shifts observed within acute wards, regardless of the ward, time of day and day of the week. Raised bedside rails, ward furniture and verbal commands were most frequently used, often quickly escalating to the use of enhanced observation, typically carried out at pace, to contain and restrict movement to the bedside. Recordable methods included the use of physical force and sedation. Our analysis demonstrates these apparently diverse range of practices cannot be understood in isolation but were utilised multiply in the care of individuals and cohorts of people living with dementia. Because their use was embedded within timetabled care, ward staff found defining and identifying restrictive interventions in their routine practices challenging, meaning these forms of restrictive practices were typically unrecognised and unrecorded. Staff experienced significant emotional impacts from using restrictive practices in patient care. We identified a range of practices to support the reduction of restrictive practice within the acute setting. These included engagement with people living with dementia, making full use of the activity resources available to the ward, and supporting people living with dementia to leave the bedside to walk within the","PeriodicalId":519880,"journal":{"name":"Health and social care delivery research","volume":"14 7","pages":"1-97"},"PeriodicalIF":0.0,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147505942","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}
Gargi Naha, Fadi Baghdadi, Alan Watkins, Alison Porter, Ann John, Bridie Angela Evans, Jenna Jones, Julia Williams, Niroshan Siriwardena, Ronan A Lyons, Sophie Harwood, Steve Goodacre, Helen Snooks, Ashrafunnesa Khanom
<p><strong>Background: </strong>Ethnic disparities in healthcare access and outcomes have been widely reported across different settings. In this scoping review, we aimed to explore whether adults from minority racial and ethnic backgrounds face higher risks of death after presenting with injuries to emergency healthcare services in high-income countries.</p><p><strong>Methods: </strong>We searched five electronic databases [Cumulative Index to Nursing and Allied Health Literature, MEDLINE, Cochrane, Scopus and PsycInfo<sup>®</sup> (American Psychological Association, Washington, DC, USA)] for peer-reviewed studies published between January 2010 and March 2024. We included studies that compared mortality outcomes by race or ethnicity in emergency healthcare settings such as ambulance services, trauma centres and hospital emergency departments in high-income countries.</p><p><strong>Results: </strong>Out of the 1873 articles identified, 32 met the inclusion criteria. Of these, 20 reported higher risk of mortality for ethnic minority patients compared to White patients following injury. Most studies were conducted in the USA with limited representation from other high-income countries such as Canada and Israel. This strong emphasis on USA-based research limits how well the findings apply to other countries with different healthcare systems. A major issue identified across the studies was the inconsistency in how race and ethnicity were recorded and reported. This lack of standardisation makes it difficult to compare results across studies and may hide the true extent of disparities.</p><p><strong>Future work: </strong>To better understand and address ethnic disparities in trauma care, future research should adopt consistent and inclusive ethnicity coding to improve data quality and comparability across studies. Studies should be conducted in a wider range of high-income countries and include pre-hospital settings, where disparities may first appear. This will help build a more globally relevant evidence base. Researchers should also take an intersectional approach, examining how ethnicity combines with other social determinants to influence outcomes. In addition to mortality, future studies using longitudinal and mixed-methods designs should explore long-term recovery and access to rehabilitation to gauge the full impact of these health disparities.</p><p><strong>Limitations: </strong>The review focused solely on mortality outcomes, limiting insight into broader health outcomes such as long-term recovery, quality of life or patient experiences. It also did not explore how ethnicity interacts with other social factors such as gender, income, disability or immigration status. These gaps obscure the full extent of inequalities in emergency care.</p><p><strong>Conclusion: </strong>This review adds to the growing evidence that ethnic minority patients in high-income countries could be at a higher risk of injury-related deaths. However, inconsistent ethn
{"title":"Ethnic differences in injury mortality rates among adult emergency healthcare service users in high-income countries: a scoping review.","authors":"Gargi Naha, Fadi Baghdadi, Alan Watkins, Alison Porter, Ann John, Bridie Angela Evans, Jenna Jones, Julia Williams, Niroshan Siriwardena, Ronan A Lyons, Sophie Harwood, Steve Goodacre, Helen Snooks, Ashrafunnesa Khanom","doi":"10.3310/GJAK4819","DOIUrl":"https://doi.org/10.3310/GJAK4819","url":null,"abstract":"<p><strong>Background: </strong>Ethnic disparities in healthcare access and outcomes have been widely reported across different settings. In this scoping review, we aimed to explore whether adults from minority racial and ethnic backgrounds face higher risks of death after presenting with injuries to emergency healthcare services in high-income countries.</p><p><strong>Methods: </strong>We searched five electronic databases [Cumulative Index to Nursing and Allied Health Literature, MEDLINE, Cochrane, Scopus and PsycInfo<sup>®</sup> (American Psychological Association, Washington, DC, USA)] for peer-reviewed studies published between January 2010 and March 2024. We included studies that compared mortality outcomes by race or ethnicity in emergency healthcare settings such as ambulance services, trauma centres and hospital emergency departments in high-income countries.</p><p><strong>Results: </strong>Out of the 1873 articles identified, 32 met the inclusion criteria. Of these, 20 reported higher risk of mortality for ethnic minority patients compared to White patients following injury. Most studies were conducted in the USA with limited representation from other high-income countries such as Canada and Israel. This strong emphasis on USA-based research limits how well the findings apply to other countries with different healthcare systems. A major issue identified across the studies was the inconsistency in how race and ethnicity were recorded and reported. This lack of standardisation makes it difficult to compare results across studies and may hide the true extent of disparities.</p><p><strong>Future work: </strong>To better understand and address ethnic disparities in trauma care, future research should adopt consistent and inclusive ethnicity coding to improve data quality and comparability across studies. Studies should be conducted in a wider range of high-income countries and include pre-hospital settings, where disparities may first appear. This will help build a more globally relevant evidence base. Researchers should also take an intersectional approach, examining how ethnicity combines with other social determinants to influence outcomes. In addition to mortality, future studies using longitudinal and mixed-methods designs should explore long-term recovery and access to rehabilitation to gauge the full impact of these health disparities.</p><p><strong>Limitations: </strong>The review focused solely on mortality outcomes, limiting insight into broader health outcomes such as long-term recovery, quality of life or patient experiences. It also did not explore how ethnicity interacts with other social factors such as gender, income, disability or immigration status. These gaps obscure the full extent of inequalities in emergency care.</p><p><strong>Conclusion: </strong>This review adds to the growing evidence that ethnic minority patients in high-income countries could be at a higher risk of injury-related deaths. However, inconsistent ethn","PeriodicalId":519880,"journal":{"name":"Health and social care delivery research","volume":" ","pages":"1-22"},"PeriodicalIF":0.0,"publicationDate":"2026-02-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147286812","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}
Natalie Adams, Oliver Stirrup, James Blackstone, Maria Krutikov, Jackie Cassell, Dorina Cadar, Catherine Henderson, Martin Knapp, Lara Goscé, Lily O'Brien, Ruth Leiser, Martyn Regan, Iona Cullen-Stephenson, Robert Fenner, Arpana Verma, Adam L Gordon, Susan Hopkins, Andrew Copas, Nick Freemantle, Paul Flowers, Laura Shallcross
<p><strong>Background: </strong>Regular severe acute respiratory syndrome coronavirus 2 testing of care home staff was introduced to reduce transmission following significant morbidity, mortality and disruption for residents early in the pandemic. However, evidence was lacking on benefits relative to disadvantages.</p><p><strong>Objectives: </strong>The VIVALDI-Clinical Trial aimed to investigate whether regular asymptomatic staff testing for severe acute respiratory syndrome coronavirus 2, alongside funding for sick pay and agency backfill, was feasible and effective in reducing severe coronavirus disease discovered in 2019-related outcomes in residents.</p><p><strong>Design and methods: </strong>VIVALDI-Clinical Trial comprised five interlinking work packages. A cluster randomised controlled trial was conducted from January to August 2023. The 'Test to Care' intervention was coproduced with the care sector.</p><p><strong>Settings and participants: </strong>Eighty-one residential/nursing homes in England providing care to adults aged ≥ 65 years. Forty-one homes were randomised to intervention and 40 to control.</p><p><strong>Interventions: </strong>Care homes were randomised 1 : 1 to intervention (twice weekly staff testing, staff sick pay and agency backfill) or control arm (national testing guidance at time of trial).</p><p><strong>Main outcome measure: </strong>Primary outcome was incidence of coronavirus disease discovered in 2019-related hospital admissions in residents.</p><p><strong>Data sources: </strong>Health data from routine national data sets were used alongside aggregate data from participating homes. Health economic and modelling analyses evaluated costs and cost-effectiveness of staff testing. Interviews with care home managers explored post-pandemic policies on staff testing, sickness pay and absence. A process evaluation was conducted to understand intervention roll-out. A mixed-study design investigated the impact of coronavirus disease discovered in 2019 outbreaks on care home residents' quality of life. Stakeholder engagement was undertaken to enable the sector to coproduce recommendations for policy-makers.</p><p><strong>Results: </strong>The trial stopped early for futility due to site recruitment and primary outcome incidence being lower than expected. There was no significant difference in resident coronavirus disease discovered in 2019-linked hospital admission incidence between intervention and control arms (incidence rate ratio 1.19, 95% confidence interval 0.55 to 2.58; <i>p</i> = 0.66). The process evaluation found that changing epidemiology, policy and social norms around coronavirus disease discovered in 2019 shaped the uptake and maintenance of testing. Interviews with care home managers suggested most homes no longer test staff, even when symptomatic, and do not pay for sickness absence outside of statutory sick pay. Modelling concluded that regular staff testing, when combined with non-pharmaceutical interventi
{"title":"Asymptomatic testing compared with standard care of the care home staff in shaping care home COVID-19 testing policy: the VIVALDI-CT pragmatic cluster RCT (VIVALDI-CT).","authors":"Natalie Adams, Oliver Stirrup, James Blackstone, Maria Krutikov, Jackie Cassell, Dorina Cadar, Catherine Henderson, Martin Knapp, Lara Goscé, Lily O'Brien, Ruth Leiser, Martyn Regan, Iona Cullen-Stephenson, Robert Fenner, Arpana Verma, Adam L Gordon, Susan Hopkins, Andrew Copas, Nick Freemantle, Paul Flowers, Laura Shallcross","doi":"10.3310/GJLS1610","DOIUrl":"https://doi.org/10.3310/GJLS1610","url":null,"abstract":"<p><strong>Background: </strong>Regular severe acute respiratory syndrome coronavirus 2 testing of care home staff was introduced to reduce transmission following significant morbidity, mortality and disruption for residents early in the pandemic. However, evidence was lacking on benefits relative to disadvantages.</p><p><strong>Objectives: </strong>The VIVALDI-Clinical Trial aimed to investigate whether regular asymptomatic staff testing for severe acute respiratory syndrome coronavirus 2, alongside funding for sick pay and agency backfill, was feasible and effective in reducing severe coronavirus disease discovered in 2019-related outcomes in residents.</p><p><strong>Design and methods: </strong>VIVALDI-Clinical Trial comprised five interlinking work packages. A cluster randomised controlled trial was conducted from January to August 2023. The 'Test to Care' intervention was coproduced with the care sector.</p><p><strong>Settings and participants: </strong>Eighty-one residential/nursing homes in England providing care to adults aged ≥ 65 years. Forty-one homes were randomised to intervention and 40 to control.</p><p><strong>Interventions: </strong>Care homes were randomised 1 : 1 to intervention (twice weekly staff testing, staff sick pay and agency backfill) or control arm (national testing guidance at time of trial).</p><p><strong>Main outcome measure: </strong>Primary outcome was incidence of coronavirus disease discovered in 2019-related hospital admissions in residents.</p><p><strong>Data sources: </strong>Health data from routine national data sets were used alongside aggregate data from participating homes. Health economic and modelling analyses evaluated costs and cost-effectiveness of staff testing. Interviews with care home managers explored post-pandemic policies on staff testing, sickness pay and absence. A process evaluation was conducted to understand intervention roll-out. A mixed-study design investigated the impact of coronavirus disease discovered in 2019 outbreaks on care home residents' quality of life. Stakeholder engagement was undertaken to enable the sector to coproduce recommendations for policy-makers.</p><p><strong>Results: </strong>The trial stopped early for futility due to site recruitment and primary outcome incidence being lower than expected. There was no significant difference in resident coronavirus disease discovered in 2019-linked hospital admission incidence between intervention and control arms (incidence rate ratio 1.19, 95% confidence interval 0.55 to 2.58; <i>p</i> = 0.66). The process evaluation found that changing epidemiology, policy and social norms around coronavirus disease discovered in 2019 shaped the uptake and maintenance of testing. Interviews with care home managers suggested most homes no longer test staff, even when symptomatic, and do not pay for sickness absence outside of statutory sick pay. Modelling concluded that regular staff testing, when combined with non-pharmaceutical interventi","PeriodicalId":519880,"journal":{"name":"Health and social care delivery research","volume":" ","pages":"1-38"},"PeriodicalIF":0.0,"publicationDate":"2026-02-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146204405","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}
Claire Goodman, Gizdem Akdur, Lisa Irvine, Jennifer Kirsty Burton, Barbara Hanratty, Anne Killett, Julienne Meyer, Ann-Marie Towers, Adam L Gordon, Rachael Carroll, Stacey Rand, Kerry Micklewright, Karen Spilsbury, Therese Lloyd, Liz Crellin, Stephen Allan, Guy Peryer, Vanessa Davey, Freya Tracey, Kaat de Corte, Nick Smith, Jo Day, Iain Lang, Liz Jones
<p><strong>Background: </strong>In England, care homes are the primary providers of long-term care for older adults. The increasing recognition of the importance of social care underscores the importance of collaboration between the National Health Service and care homes. The lack of data sharing among stakeholders limits opportunities for co-ordinated care, service development and research.</p><p><strong>Objectives: </strong>Identify how to support research, service development and innovation in care homes. Combine existing evidence with care home-generated resident data to create a minimum data set that is relevant and usable for stakeholders, including residents, relatives, practitioners, researchers, regulators and commissioners.</p><p><strong>Design and methods: </strong>The study used a mixed-methods approach, structured into five work packages, supported by patient and public involvement and engagement with residents, carers and staff: <b>Work package 1:</b> Conducted two evidence reviews on outcome measures and factors enhancing research productivity in care homes. <b>Work package 2:</b> Created a trial archive for secondary data analysis. <b>Work package 3:</b> Conducted a scoping review, a realist review and a national survey to define minimum data set content and assess implementation challenges in English care homes. <b>Work package 4:</b> Linked residents' data from National Health Service and social care data sets with data from study care homes, deriving useful minimum data set variables and assessing data quality. <b>Work package 5:</b> Piloted the minimum data set at two points in care homes within three integrated care systems, conducted focus groups and interviews with care home and integrated care system staff. Three national consultations explored how stakeholders use resident information, measure quality of life and minimum data set usefulness. Additionally, subprojects examined data availability in domiciliary settings, staff reasoning when assessing resident well-being and completing research during rapid policy changes.</p><p><strong>Findings: </strong>The reviews revealed significant heterogeneity in outcome measurement and questioned the appropriateness of some methods and measures used for care home research. The Virtual International Care Home Trials Archive merged data from 6 United Kingdom randomised controlled trials with 5674 residents across 308 care homes. International minimum data set studies are a valuable resource for international comparative research. The wide range of measures used are mostly clinical with under-representation of measures important to care homes (e.g. quality of life). A national survey of care homes demonstrated the range of information, including clinical measures being routinely collected. The realist review identified motivation, front-line staff monitoring and embedded recording systems as important for minimum data set implementation. The pilot study recruited 996 residents from 45
{"title":"Developing research resources and minimum data set for care homes' adoption and use (DACHA).","authors":"Claire Goodman, Gizdem Akdur, Lisa Irvine, Jennifer Kirsty Burton, Barbara Hanratty, Anne Killett, Julienne Meyer, Ann-Marie Towers, Adam L Gordon, Rachael Carroll, Stacey Rand, Kerry Micklewright, Karen Spilsbury, Therese Lloyd, Liz Crellin, Stephen Allan, Guy Peryer, Vanessa Davey, Freya Tracey, Kaat de Corte, Nick Smith, Jo Day, Iain Lang, Liz Jones","doi":"10.3310/PKFR6453","DOIUrl":"https://doi.org/10.3310/PKFR6453","url":null,"abstract":"<p><strong>Background: </strong>In England, care homes are the primary providers of long-term care for older adults. The increasing recognition of the importance of social care underscores the importance of collaboration between the National Health Service and care homes. The lack of data sharing among stakeholders limits opportunities for co-ordinated care, service development and research.</p><p><strong>Objectives: </strong>Identify how to support research, service development and innovation in care homes. Combine existing evidence with care home-generated resident data to create a minimum data set that is relevant and usable for stakeholders, including residents, relatives, practitioners, researchers, regulators and commissioners.</p><p><strong>Design and methods: </strong>The study used a mixed-methods approach, structured into five work packages, supported by patient and public involvement and engagement with residents, carers and staff: <b>Work package 1:</b> Conducted two evidence reviews on outcome measures and factors enhancing research productivity in care homes. <b>Work package 2:</b> Created a trial archive for secondary data analysis. <b>Work package 3:</b> Conducted a scoping review, a realist review and a national survey to define minimum data set content and assess implementation challenges in English care homes. <b>Work package 4:</b> Linked residents' data from National Health Service and social care data sets with data from study care homes, deriving useful minimum data set variables and assessing data quality. <b>Work package 5:</b> Piloted the minimum data set at two points in care homes within three integrated care systems, conducted focus groups and interviews with care home and integrated care system staff. Three national consultations explored how stakeholders use resident information, measure quality of life and minimum data set usefulness. Additionally, subprojects examined data availability in domiciliary settings, staff reasoning when assessing resident well-being and completing research during rapid policy changes.</p><p><strong>Findings: </strong>The reviews revealed significant heterogeneity in outcome measurement and questioned the appropriateness of some methods and measures used for care home research. The Virtual International Care Home Trials Archive merged data from 6 United Kingdom randomised controlled trials with 5674 residents across 308 care homes. International minimum data set studies are a valuable resource for international comparative research. The wide range of measures used are mostly clinical with under-representation of measures important to care homes (e.g. quality of life). A national survey of care homes demonstrated the range of information, including clinical measures being routinely collected. The realist review identified motivation, front-line staff monitoring and embedded recording systems as important for minimum data set implementation. The pilot study recruited 996 residents from 45 ","PeriodicalId":519880,"journal":{"name":"Health and social care delivery research","volume":"14 3","pages":"1-43"},"PeriodicalIF":0.0,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146151785","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}
Julie Nightingale, Beverly Snaith, Sarah Etty, Trudy Sevens, Robert Appleyard, Shona Kelly, Sally Fowler-Davis
<p><strong>Background: </strong>Demand for imaging in England massively outstrips supply in terms of workforce capacity, with well-documented shortages of both radiographers and radiologists. The COVID-19 pandemic exacerbated already stretched services, which have remained 'in crisis'. Three high profile national reports highlighted the urgent need to develop the capacity and capability of the imaging support workforce, yet it is unclear how this vital workforce is utilised.</p><p><strong>Aim: </strong>To investigate the development, deployment and contribution of the support workforce to diagnostic imaging activity across England to determine effective models of practice that will support future workforce transformation and re-design. Research question: What models of deployment of the support workforce exist within diagnostic imaging departments and what service, hospital, regional and national factors may encourage or inhibit implementation of these models?</p><p><strong>Design: </strong>The study employed a mixed-methods explanatory research design, comprising six consecutive workstreams spanning 27 months: (Workstream 1) scoping review; (Workstream 2) census of imaging workforce; (Workstream 3) engagement with imaging networks; (Workstream 4) deep dive review of selected trusts; (Workstream 5) qualitative case studies; (Workstream 6) determinant framework.</p><p><strong>Setting and participants: </strong>All National Health Service diagnostic imaging (radiology) services and imaging networks located within England were in scope. Participants included imaging network representatives (<i>n</i> = 18), radiology service managers (<i>n</i> = 24), and Imaging Support Workers and Assistant Practitioners, their supervisors and department managers (WS5, <i>n</i> = 113).</p><p><strong>Interventions: </strong>This was an exploratory observational study.</p><p><strong>Outcome measures: </strong>Findings were synthesised to create a determinant framework (Maturity Matrix) for the effective deployment of the imaging support workforce. A Public Summary encapsulated the key findings for imaging services, the wider healthcare community, and for patients and the public.</p><p><strong>Data sources: </strong>National Health Service Electronic Staff Record database (<i>n</i> = 144 National Health Service Trusts); interviews (<i>n</i> = 38); focus groups (<i>n</i> = 15); documentary analysis (<i>n</i> = 48).</p><p><strong>Results: </strong>The support workforce (National Health Service pay Bands 2-4) constitutes 23.6% of the non-medical imaging workforce (22.2% median, interquartile range 14.9-29.1). Opposing deployment models were identified, based on grade preference (Band 2 or Band 3) and role flexibility (static or rotational). Wide variations in job titles, roles, grades, competencies and scopes of practice are evident both between National Health Service Trust hospitals and within individual imaging departments. With the exception of breast imaging, assista
{"title":"Utilisation of the support workforce in diagnostic imaging: a mixed-methods investigation.","authors":"Julie Nightingale, Beverly Snaith, Sarah Etty, Trudy Sevens, Robert Appleyard, Shona Kelly, Sally Fowler-Davis","doi":"10.3310/GJJN0626","DOIUrl":"https://doi.org/10.3310/GJJN0626","url":null,"abstract":"<p><strong>Background: </strong>Demand for imaging in England massively outstrips supply in terms of workforce capacity, with well-documented shortages of both radiographers and radiologists. The COVID-19 pandemic exacerbated already stretched services, which have remained 'in crisis'. Three high profile national reports highlighted the urgent need to develop the capacity and capability of the imaging support workforce, yet it is unclear how this vital workforce is utilised.</p><p><strong>Aim: </strong>To investigate the development, deployment and contribution of the support workforce to diagnostic imaging activity across England to determine effective models of practice that will support future workforce transformation and re-design. Research question: What models of deployment of the support workforce exist within diagnostic imaging departments and what service, hospital, regional and national factors may encourage or inhibit implementation of these models?</p><p><strong>Design: </strong>The study employed a mixed-methods explanatory research design, comprising six consecutive workstreams spanning 27 months: (Workstream 1) scoping review; (Workstream 2) census of imaging workforce; (Workstream 3) engagement with imaging networks; (Workstream 4) deep dive review of selected trusts; (Workstream 5) qualitative case studies; (Workstream 6) determinant framework.</p><p><strong>Setting and participants: </strong>All National Health Service diagnostic imaging (radiology) services and imaging networks located within England were in scope. Participants included imaging network representatives (<i>n</i> = 18), radiology service managers (<i>n</i> = 24), and Imaging Support Workers and Assistant Practitioners, their supervisors and department managers (WS5, <i>n</i> = 113).</p><p><strong>Interventions: </strong>This was an exploratory observational study.</p><p><strong>Outcome measures: </strong>Findings were synthesised to create a determinant framework (Maturity Matrix) for the effective deployment of the imaging support workforce. A Public Summary encapsulated the key findings for imaging services, the wider healthcare community, and for patients and the public.</p><p><strong>Data sources: </strong>National Health Service Electronic Staff Record database (<i>n</i> = 144 National Health Service Trusts); interviews (<i>n</i> = 38); focus groups (<i>n</i> = 15); documentary analysis (<i>n</i> = 48).</p><p><strong>Results: </strong>The support workforce (National Health Service pay Bands 2-4) constitutes 23.6% of the non-medical imaging workforce (22.2% median, interquartile range 14.9-29.1). Opposing deployment models were identified, based on grade preference (Band 2 or Band 3) and role flexibility (static or rotational). Wide variations in job titles, roles, grades, competencies and scopes of practice are evident both between National Health Service Trust hospitals and within individual imaging departments. With the exception of breast imaging, assista","PeriodicalId":519880,"journal":{"name":"Health and social care delivery research","volume":"14 4","pages":"1-44"},"PeriodicalIF":0.0,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147277820","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}
Kate Honeyford, Graham Cooke, Anne Kinderler, John Welch, Andrew Brent, Ben Glampson, Sarah Tonkin-Crine, Runa Lazzarino, Shashank Patil, Peter Ghazal, Pippa Goodman, Ron Daniels, Anthony Gordon, Ceire Costelloe
<p><strong>Background: </strong>Identifying clinical deterioration is a global health priority. Sepsis is a leading cause of deterioration, responsible for around 46,000 deaths annually in the United Kingdom. Early warning scores based on patients' vital signs can be embedded into electronic patient records to digitally alert clinicians to those at risk. Rapid identification and treatment - particularly with targeted intravenous antibiotics - are critical to improving outcomes in sepsis patients.</p><p><strong>Research question: </strong>This study aimed to evaluate the effectiveness of digital alerts in improving outcomes for patients with sepsis. Using routine electronic patient record data from four United Kingdom National Health Service acute trusts, we investigated how digital alert systems influence patient outcomes and explored mechanisms and mediators of their effectiveness.</p><p><strong>Objectives: </strong>Map the types of digital alerts currently in use across United Kingdom hospitals for identifying patients at risk of sepsis (Workstream 1). Evaluate the impact of digital alerts on patient outcomes (Workstream 2). Examine how the implementation process affects alert performance, guided by the consolidated framework for implementation research (Workstream 3). Provide recommendations on alert effectiveness and implementation strategies using systems modelling and mediation analysis (Workstream 4).</p><p><strong>Methods: </strong>A mixed-methods approach was employed. A national survey assessed the use of digital sepsis alerts in English National Health Survey hospitals (Workstream 1). Qualitative interviews and focus groups explored the implementation process and its influence on alert performance (Workstream 3). A natural experiment with multilevel interrupted time series analysis examined the impact of sepsis screening tools and digital alerts on outcomes, primarily in-hospital mortality (Workstream 2). Routinely collected clinical data were processed following National Institute for Health Research-Health Information Collaborative standards. Combining quantitative and qualitative data enabled us to link implementation processes with patient outcomes.</p><p><strong>Results: </strong>All four trusts experienced reduced mortality rates among patients with serious infections following the introduction of digital sepsis screening tools. After adjustment for patient case-mix, admission patterns and pre-existing trends, one trust showed a statistically significant decrease in mortality linked to digital alert implementation. In two trusts, older patients experienced greater mortality reduction than younger ones following alert introduction. Qualitative findings highlighted factors contributing to more effective use of digital alerts: deployment in general wards rather than intensive care units; use by clinicians familiar with similar technologies; availability of 24/7 emergency outreach teams; robust technological infrastructure and alerts
{"title":"Digital alerting to improve sepsis detection and patient outcomes in NHS Trusts: a multi-methods study.","authors":"Kate Honeyford, Graham Cooke, Anne Kinderler, John Welch, Andrew Brent, Ben Glampson, Sarah Tonkin-Crine, Runa Lazzarino, Shashank Patil, Peter Ghazal, Pippa Goodman, Ron Daniels, Anthony Gordon, Ceire Costelloe","doi":"10.3310/GJCC0605","DOIUrl":"10.3310/GJCC0605","url":null,"abstract":"<p><strong>Background: </strong>Identifying clinical deterioration is a global health priority. Sepsis is a leading cause of deterioration, responsible for around 46,000 deaths annually in the United Kingdom. Early warning scores based on patients' vital signs can be embedded into electronic patient records to digitally alert clinicians to those at risk. Rapid identification and treatment - particularly with targeted intravenous antibiotics - are critical to improving outcomes in sepsis patients.</p><p><strong>Research question: </strong>This study aimed to evaluate the effectiveness of digital alerts in improving outcomes for patients with sepsis. Using routine electronic patient record data from four United Kingdom National Health Service acute trusts, we investigated how digital alert systems influence patient outcomes and explored mechanisms and mediators of their effectiveness.</p><p><strong>Objectives: </strong>Map the types of digital alerts currently in use across United Kingdom hospitals for identifying patients at risk of sepsis (Workstream 1). Evaluate the impact of digital alerts on patient outcomes (Workstream 2). Examine how the implementation process affects alert performance, guided by the consolidated framework for implementation research (Workstream 3). Provide recommendations on alert effectiveness and implementation strategies using systems modelling and mediation analysis (Workstream 4).</p><p><strong>Methods: </strong>A mixed-methods approach was employed. A national survey assessed the use of digital sepsis alerts in English National Health Survey hospitals (Workstream 1). Qualitative interviews and focus groups explored the implementation process and its influence on alert performance (Workstream 3). A natural experiment with multilevel interrupted time series analysis examined the impact of sepsis screening tools and digital alerts on outcomes, primarily in-hospital mortality (Workstream 2). Routinely collected clinical data were processed following National Institute for Health Research-Health Information Collaborative standards. Combining quantitative and qualitative data enabled us to link implementation processes with patient outcomes.</p><p><strong>Results: </strong>All four trusts experienced reduced mortality rates among patients with serious infections following the introduction of digital sepsis screening tools. After adjustment for patient case-mix, admission patterns and pre-existing trends, one trust showed a statistically significant decrease in mortality linked to digital alert implementation. In two trusts, older patients experienced greater mortality reduction than younger ones following alert introduction. Qualitative findings highlighted factors contributing to more effective use of digital alerts: deployment in general wards rather than intensive care units; use by clinicians familiar with similar technologies; availability of 24/7 emergency outreach teams; robust technological infrastructure and alerts","PeriodicalId":519880,"journal":{"name":"Health and social care delivery research","volume":"14 5","pages":"1-23"},"PeriodicalIF":0.0,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147345931","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}
<p><strong>Background: </strong>The National Health Service in England is piloting an extension of access to its Digital Weight Management Programme, a digital service to support behavioural and lifestyle changes for weight loss. Access is being piloted to include referrals for patients with a body mass index above a threshold level set by the National Health Service England and who either have a diagnosis of osteoarthritis of the knee or hip (musculoskeletal referrals - 11 pilot sites) or are on elective surgical care waiting lists (elective care referrals - 10 pilot sites). There is a marked variation across sites in the number of patients referred.</p><p><strong>Objectives: </strong>To understand reasons for variation (local implementation, barriers and facilitators) and experiences of the implementation and functioning of referral pathways for musculoskeletal and elective surgical care patients into the National Health Service Digital Weight Management Programme.</p><p><strong>Design and methods: </strong>A comparative case study (<i>n</i> = 7 sites) methodology was used, employing a mixed-methods approach following a sequential explanatory design: descriptive analysis of quantitative referral data from National Health Service England; staff (<i>n</i> = 25) and patient (<i>n</i> = 18) interviews and online workshops. Thematic analysis was conducted.</p><p><strong>Setting: </strong>Osteoarthritis treatment and elective surgery providers in the National Health Service in England.</p><p><strong>Participants: </strong>Interviews: staff and patients at three musculoskeletal and four elective care pilot sites. Workshops: staff at all pilot sites.</p><p><strong>Intervention: </strong>Referral of osteoarthritis and elective surgery patients to the National Health Service Digital Weight Management Programme.</p><p><strong>Main outcome measures: </strong>Patients' and staff's views.</p><p><strong>Results: </strong>Sites that created referral processes that optimised clinical staff time (e.g. automation and use of administrative staff) and involved ways to capture body mass index if missing from patient records were more likely to have a higher number of referrals. Despite generally positive attitudes towards the Programme, many staff felt they had insufficient information to describe it accurately to patients, which may impact both offering and acceptance of referrals. Strong leadership and personal staff motivation are also likely to impact referral offers. Similarly, patients were more likely to accept a referral if it aligned with their attitudes towards weight management and was offered at a time where they felt they could engage with the Programme.</p><p><strong>Limitations: </strong>Data were available on numbers of patients referred but not on numbers of eligible patients not referred. All patients interviewed had accepted referral to the Programme: we were unsuccessful in our attempts to recruit patients who had declined referral. No patients f
{"title":"Referral pathways into the NHS Digital Weight Management Programme for musculoskeletal and perioperative patients: rapid process evaluation.","authors":"Stephanie Stockwell, Maggie Bradford, Zuzanna Marciniak-Nuqui, Saoirse Moriarty, Justin Waring, Jon Sussex","doi":"10.3310/GJJS9715","DOIUrl":"https://doi.org/10.3310/GJJS9715","url":null,"abstract":"<p><strong>Background: </strong>The National Health Service in England is piloting an extension of access to its Digital Weight Management Programme, a digital service to support behavioural and lifestyle changes for weight loss. Access is being piloted to include referrals for patients with a body mass index above a threshold level set by the National Health Service England and who either have a diagnosis of osteoarthritis of the knee or hip (musculoskeletal referrals - 11 pilot sites) or are on elective surgical care waiting lists (elective care referrals - 10 pilot sites). There is a marked variation across sites in the number of patients referred.</p><p><strong>Objectives: </strong>To understand reasons for variation (local implementation, barriers and facilitators) and experiences of the implementation and functioning of referral pathways for musculoskeletal and elective surgical care patients into the National Health Service Digital Weight Management Programme.</p><p><strong>Design and methods: </strong>A comparative case study (<i>n</i> = 7 sites) methodology was used, employing a mixed-methods approach following a sequential explanatory design: descriptive analysis of quantitative referral data from National Health Service England; staff (<i>n</i> = 25) and patient (<i>n</i> = 18) interviews and online workshops. Thematic analysis was conducted.</p><p><strong>Setting: </strong>Osteoarthritis treatment and elective surgery providers in the National Health Service in England.</p><p><strong>Participants: </strong>Interviews: staff and patients at three musculoskeletal and four elective care pilot sites. Workshops: staff at all pilot sites.</p><p><strong>Intervention: </strong>Referral of osteoarthritis and elective surgery patients to the National Health Service Digital Weight Management Programme.</p><p><strong>Main outcome measures: </strong>Patients' and staff's views.</p><p><strong>Results: </strong>Sites that created referral processes that optimised clinical staff time (e.g. automation and use of administrative staff) and involved ways to capture body mass index if missing from patient records were more likely to have a higher number of referrals. Despite generally positive attitudes towards the Programme, many staff felt they had insufficient information to describe it accurately to patients, which may impact both offering and acceptance of referrals. Strong leadership and personal staff motivation are also likely to impact referral offers. Similarly, patients were more likely to accept a referral if it aligned with their attitudes towards weight management and was offered at a time where they felt they could engage with the Programme.</p><p><strong>Limitations: </strong>Data were available on numbers of patients referred but not on numbers of eligible patients not referred. All patients interviewed had accepted referral to the Programme: we were unsuccessful in our attempts to recruit patients who had declined referral. No patients f","PeriodicalId":519880,"journal":{"name":"Health and social care delivery research","volume":" ","pages":"1-35"},"PeriodicalIF":0.0,"publicationDate":"2026-01-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146101133","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}
Polly Radcliffe, Brid Featherstone, Narendra Aladangady, Margaret Maxwell, Joanne Neale, Lynne Gilmour, Louise Honeybul, Shirley Lewis, Emma Smith, Mariana Gonzalez Utrilla, Helen Cheyne
<p><strong>Background: </strong>Women who use drugs during the perinatal period often have complex health and social care needs. Their infants can experience developmental and health problems. Despite United Kingdom's guidelines and policies on the care of pregnant women and mothers who use drugs, there is little evidence of the services that are available in the United Kingdom and whether they meet the needs of women and their infants. This study sought evidence of (1) best practice models for care that have the potential to interrupt the transmission of adversity across generations and (2) the views and experiences of women and staff on different models of care and how services could be improved. The study involved systematic reviews, longitudinal qualitative research and coproduction. There were three phases. In phase 1, an Expert Advisory and CoProduction Group was established to guide the research and to develop a theory of change for improved service models. The group comprised multidisciplinary stakeholders from health and social care and peer advisers. Two reviews were undertaken: A scoping review of UK guidance for perinatal care for women who use drugs included 111 documents, recommending integrated multidisciplinary working. A mixed-methods systematic review of evidence of integrated models of perinatal care for women who use drugs and their babies reviewed 197 studies. Qualitative findings suggest that women appreciate collocated services that are easy to access. Quantitative findings found evidence that integrated programmes at the point of delivery decrease substance use during the perinatal period. Phase 2 involved a qualitative longitudinal study in four sites, two in England and two in Scotland, that aimed to explore perinatal care pathways. Up to five interviews were conducted with 36 women, from early pregnancy up to 18 months post natal (131 interviews). Many women experienced stigma and were anxious about social services' involvement. Access to residential treatment and mental health support was uneven. Support for women who had lost care of their babies was poor. Focus group interviews (79 staff) and individual interviews (21 staff) were conducted with health and social care practitioners. Staff reported that high caseloads, staff turnover and training gaps contributed to difficulties in providing care to this challenging group. In phase 3, the Expert Advisory and CoProduction Group worked with the research team to develop a theory of change for recommendations for an optimised service model. The theory of change identified eight key recommendations and emphasised that a whole-system approach is required to meet the complex needs of this population.</p><p><strong>Limitations: </strong>For the quantitative findings of the mixed-methods systematic review, the diversity of study types made it difficult to draw firm conclusions on the effectiveness of different approaches. Not all women recruited to the qualitative longitudinal
{"title":"Models of perinatal care for women using drugs and their infants: synopsis of The Stepping Stones Study.","authors":"Polly Radcliffe, Brid Featherstone, Narendra Aladangady, Margaret Maxwell, Joanne Neale, Lynne Gilmour, Louise Honeybul, Shirley Lewis, Emma Smith, Mariana Gonzalez Utrilla, Helen Cheyne","doi":"10.3310/GJPR0411","DOIUrl":"10.3310/GJPR0411","url":null,"abstract":"<p><strong>Background: </strong>Women who use drugs during the perinatal period often have complex health and social care needs. Their infants can experience developmental and health problems. Despite United Kingdom's guidelines and policies on the care of pregnant women and mothers who use drugs, there is little evidence of the services that are available in the United Kingdom and whether they meet the needs of women and their infants. This study sought evidence of (1) best practice models for care that have the potential to interrupt the transmission of adversity across generations and (2) the views and experiences of women and staff on different models of care and how services could be improved. The study involved systematic reviews, longitudinal qualitative research and coproduction. There were three phases. In phase 1, an Expert Advisory and CoProduction Group was established to guide the research and to develop a theory of change for improved service models. The group comprised multidisciplinary stakeholders from health and social care and peer advisers. Two reviews were undertaken: A scoping review of UK guidance for perinatal care for women who use drugs included 111 documents, recommending integrated multidisciplinary working. A mixed-methods systematic review of evidence of integrated models of perinatal care for women who use drugs and their babies reviewed 197 studies. Qualitative findings suggest that women appreciate collocated services that are easy to access. Quantitative findings found evidence that integrated programmes at the point of delivery decrease substance use during the perinatal period. Phase 2 involved a qualitative longitudinal study in four sites, two in England and two in Scotland, that aimed to explore perinatal care pathways. Up to five interviews were conducted with 36 women, from early pregnancy up to 18 months post natal (131 interviews). Many women experienced stigma and were anxious about social services' involvement. Access to residential treatment and mental health support was uneven. Support for women who had lost care of their babies was poor. Focus group interviews (79 staff) and individual interviews (21 staff) were conducted with health and social care practitioners. Staff reported that high caseloads, staff turnover and training gaps contributed to difficulties in providing care to this challenging group. In phase 3, the Expert Advisory and CoProduction Group worked with the research team to develop a theory of change for recommendations for an optimised service model. The theory of change identified eight key recommendations and emphasised that a whole-system approach is required to meet the complex needs of this population.</p><p><strong>Limitations: </strong>For the quantitative findings of the mixed-methods systematic review, the diversity of study types made it difficult to draw firm conclusions on the effectiveness of different approaches. Not all women recruited to the qualitative longitudinal ","PeriodicalId":519880,"journal":{"name":"Health and social care delivery research","volume":"14 2","pages":"1-36"},"PeriodicalIF":0.0,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146014021","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}
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