Zoebia Islam, Kristian Pollock, Anne Patterson, Matilda Hanjari, Louise Wallace, Irfhan Mururajani, Simon Conroy, Christina Faull
Background: 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.
Objective: 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?
Design: 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.
Setting: The study was set in Nottinghamshire and Leicestershire in the UK.
Results: 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.
Limitations: It was attempted to include a broad ethnic diversity in the sample, but the authors acknowledge that not all groups could be included.
Conclusions: 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.
Future work: Priorities for future research: How can health professionals identify if/w
{"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, Kristian Pollock, Anne Patterson, Matilda Hanjari, Louise Wallace, Irfhan Mururajani, Simon Conroy, 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}
Ross Millar, Justin Avery Aunger, Anne Marie Rafferty, Joanne Greenhalgh, Russell Mannion, Hugh McLeod, Deborah Faulks
Background: 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.
Objectives: 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.
Design: A realist synthesis was carried out to develop, test and refine theories about how interorganisational collaborations work, for whom and in what circumstances.
Data sources: Data sources were gathered from peer-reviewed and grey literature, realist interviews with 34 stakeholders and a focus group with patient and public representatives.
Review methods: 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.
Results: 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.
Limitations: 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.
{"title":"Towards achieving interorganisational collaboration between health-care providers: a realist evidence synthesis.","authors":"Ross Millar, Justin Avery Aunger, Anne Marie Rafferty, Joanne Greenhalgh, Russell Mannion, Hugh McLeod, 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}
Joanne Turnbull, Jennifer MacLellan, Kate Churruca, Louise A Ellis, Jane Prichard, David Browne, Jeffrey Braithwaite, Emily Petter, Matthew Chisambi, Catherine Pope
Background: NHS 111 online offers 24-hour access to health assessment and triage.
Objectives: 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.
Design: 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.
Results: 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.
Conclusions: 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.
Limitations: 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.
Future work: 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.
{"title":"A multimethod study of NHS 111 online.","authors":"Joanne Turnbull, Jennifer MacLellan, Kate Churruca, Louise A Ellis, Jane Prichard, David Browne, Jeffrey Braithwaite, Emily Petter, Matthew Chisambi, 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}
Carl Thompson, Teumzghi Mebrahtu, Sarah Skyrme, Karen Bloor, Deidre Andre, Anne Maree Keenan, Alison Ledward, Huiqin Yang, Rebecca Randell
Background: 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.
Objectives: 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.
Eligibility criteria: 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.
Information sources: Nineteen bibliographic databases searched October 2019 and February 2021.
Risk of bias: Assessed using structured risk of bias guidelines; almost all included studies were at high risk of bias.
Synthesis of results: 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.
Included studies: 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.
Evidence limitations: 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.
{"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, Teumzghi Mebrahtu, Sarah Skyrme, Karen Bloor, Deidre Andre, Anne Maree Keenan, Alison Ledward, Huiqin Yang, 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}
Lindsay Blank, Anna Cantrell, Katie Sworn, Andrew Booth
Background: 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.
Methods: 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.
Results: 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 (n = 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.
Conclusions: 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
{"title":"Factors which facilitate or impede patient engagement with pulmonary and cardiac rehabilitation: a rapid evaluation mapping review.","authors":"Lindsay Blank, Anna Cantrell, Katie Sworn, 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}
N. Evans, D. Edwards, Judith Carrier, Mair Elliott, Elizabeth Gillen, B. Hannigan, Rhiannon Lane, Liz Williams
Mental 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. The 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. All 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. One 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
{"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}
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
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. 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]. 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. 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
{"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}
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
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
背景:急诊手术与非急诊手术策略(包括医疗管理、非外科手术和选择性手术)相比，对住院常见急性胃肠道疾病患者的临床效果和成本效益需要证据。我们旨在评估两种策略(即急诊手术与非急诊手术策略)对五种常见急症患者的相对临床效果;(2)五种常见急性病的成本效益;(3)针对特定患者亚群的替代策略的临床效果和成本效益。方法从2010年4月1日至2019年12月31日期间英国175家急性医院急诊收治的急性阑尾炎、胆结石、憩室病、腹壁疝或肠梗阻的成人记录中提取，并与英国国家统计局的死亡率数据相关联。使用经临床专家组共识同意的《国际疾病和相关健康问题统计分类第十版》诊断代码确定资格。接受紧急手术的病人是根据人口普查和调查办公室的程序代码确定的。该研究通过工具变量设计解决了潜在的无法测量的混杂。工具变量是每家医院使用紧急手术与非紧急手术策略的倾向。主要指标是90天的“存活和出院天数”。我们报告了替代策略的总体相对有效性，以及预先指定的亚组(即年龄，合并症数量和虚弱程度)。成本效益分析利用相关数据中的资源利用和死亡率，得出增量成本、质量调整寿命年和1年增量净货币效益的估计。结果队列大小如下:阑尾炎患者268,144人，胆结石患者240,977人，憩室疾病患者138,869人，疝气患者106,432人，肠梗阻患者133,073人。总的来说，在1年，平均存活天数和90天出院天数，成本和质量调整生命年在两种策略下相似，在调整混杂因素后。总的来说，对于五种情况中的每一种，增量净货币效益估计的95%置信区间(ci)都包括零。对于严重虚弱的患者，紧急手术导致存活和出院天数减少，与非紧急手术相比，其成本效益不高，阑尾炎的增量净货币效益估计为- 18,727英镑(95% CI - 23,900英镑至- 13,600英镑)，胆石症的增量净货币效益估计为- 7700英镑(95% CI - 13,000英镑至- 2370英镑)，憩室病的增量净货币效益估计为- 9230英镑(95% CI - 24,300英镑至5860英镑)。-疝气- 16,600英镑(95% CI - 21,100英镑- 12,000英镑)，肠梗阻- 19,300英镑(95% CI - 25,600英镑- 13,000英镑)。对于“适合”的患者，急诊手术相对具有成本效益，估计憩室疾病的净增量货币效益估计为5180英镑(95% CI为684英镑至9680英镑)，疝气为2040英镑(95% CI为996英镑至3090英镑)，肠梗阻为7850英镑(95% CI为5020英镑至10700英镑)，阑尾炎为369英镑(95% CI为728英镑至1460英镑)，胆结石为718英镑(95% CI为294英镑至1140英镑)。公众和患者参与翻译研讨会的参与者强调，这些发现应该广泛提供给未来的手术决策。工具变量方法不能消除混淆的风险，急性医院的观点排除了其他提供者的成本。结论两种策略总体上都不具有更高的成本效益。对于严重虚弱的患者，非急诊手术策略相对具有成本效益。对于身体健康的患者，紧急手术更具成本效益。对于患有多种长期疾病的患者，需要进一步的研究来评估急诊手术的收益和成本。研究注册本研究注册号为reviewregistry784。该项目由国家卫生和保健研究所(IHR)卫生和社会保健提供研究方案资助，将全文发表在《卫生和社会保健提供研究》上;第11卷第1期请参阅NIHR期刊图书馆网站了解更多项目信息。
{"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}
A. O’Cathain, Alexis Foster, Chris Carroll, L. Preston, M. Ogden, M. Clowes, J. Protheroe
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. 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. 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. This study was a systematic review with stakeholder involvement. 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. 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
{"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}
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
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. 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. Risk modelling study linking existing data. NHS adult critical care units and acute hospitals in England. Patients admitted to an adult critical care unit or experiencing an in-hospital cardiac arrest. None. 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. 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. 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. Delays in obtaining linked data resulted in the data used being 5 years old at the point of publication: models
国家卫生与保健研究所先前的一项研究【Harrison DA，Ferrando Vivas P，Shahin J，Rowan KM。确保医疗保健提供者的比较是公平的：开发和验证危重患者的风险预测模型。卫生服务Deliv Res 2015；3（41）]确定需要进行更多的研究，以了解重症监护的风险因素和后果以及随后的结果。首先，通过开发固定时间点和事件发生时间的死亡率、终末期肾病、2型糖尿病、医疗保健利用率和成本的模型，改进成人普通重症监护的风险模型。其次，通过增强风险因素数据和开发长期死亡率模型来改进心胸重症监护的风险模型。第三，通过增强风险因素数据和开发长期死亡率和重症监护利用率模型，改进院内心脏骤停的风险模型。连接现有数据的风险建模研究。英国国家医疗服务体系成人重症监护室和急诊医院。入住成人重症监护室或经历住院心脏骤停的患者。没有一个重症监护病房入院后30天、90天和1年的出院死亡率；急性出院后1年的死亡率；终末期肾病或2型糖尿病的新诊断；医院资源使用和成本；自发循环的恢复持续> 20分钟；存活至出院和1年；以及住院心脏骤停后在重症监护室的住院时间。病例混合计划、国家心脏骤停审计、英国肾脏登记处、国家糖尿病审计、国家成人心脏外科审计、医院事件统计和国家统计局。数据关联了2009年4月1日至2016年3月31日期间965576名重症监护入院患者和2011年4月31日至2016年间83939名住院心脏骤停患者。对于进入成人重症监护室的患者，30天死亡率模型的预测因子和表现与医院死亡率模型相似，并且没有减少异质性。长期结果的模型反映了慢性预测因素比急性预测因素更重要。终末期肾病和糖尿病的新模型将使重症监护室能够根据这些重要结果进行基准测试，并确定需要加强随访的患者。医疗费用最有力的预测因素是既往住院、既往依赖和慢性病。在心胸重症监护模型中添加术前和术中风险因素对表现几乎没有改善。在住院心脏骤停模型中添加合并症提供了适度的改善，但对长期结果更为重要。延迟获取相关数据导致使用的数据在发布时已有5年历史：模型已经需要重新校准。数据链接以额外的预测因素和新的结果衡量标准的形式，增强了支持国家临床审计的风险模型。本报告中开发的新模型可能有助于为患者及其家人提供潜在结果的客观估计。（1） 针对最需要的人，制定和测试危重症后康复的护理途径；（2） 探索其他相关数据来源，以取得长期成果；（3） 扩大资源使用和成本与初级保健、门诊和急诊科数据的数据链接。本研究注册号为NCT02454257。该项目由国家卫生与护理研究所（NIHR）卫生与社会护理提供研究计划资助，并将在《卫生与社会保健提供研究》上全文发表；第10卷，第39期。有关更多项目信息，请访问NIHR期刊图书馆网站。
{"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}
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