ww.yhahsn.org.uk

Transforming Healthcare

Rebecca LawtonProfessor, University of Leeds and Bradford

Institute for Health Research

@CLAHRC_LYB @YHANSNP @CLAHRC_SY #AHSN Eventwww.clahrc-lyb.nihr.ac.uk www.yhahsn.org.uk www.clahrc-sy.nihr.ac.uk

@CLAHRC_LYB @AHSN_YandH @CLAHRC_SY #AHSN Event

What is transformation?• Fundamental or incremental change• Top down or bottom up• Driven by data, technology, new relationships…• Change in structures, processes, culture and behaviour

www.clahrc-lyb.nihr.ac.uk www.yhahsn.org.uk www.clahrc-sy.nihr.ac.uk

@CLAHRC_LYB @AHSN_YandH @CLAHRC_SY #AHSN Event

The AHSN role in transformation

www.clahrc-lyb.nihr.ac.uk www.yhahsn.org.uk www.clahrc-sy.nihr.ac.uk

@CLAHRC_LYB @AHSN_YandH @CLAHRC_SY #AHSN Event

Co-production

Data driven

Bottom-up

Incremental and

fundamental change

New relationships

Culture change

Top-down

The active ingredients of the AHSN

• Positive practice network• Good improvement practice training• Peer-to-peer review• Patient engagement • Training and Action for Patient Safety• Behaviour change methods

www.clahrc-lyb.nihr.ac.uk www.yhahsn.org.uk www.clahrc-sy.nihr.ac.uk

@CLAHRC_LYB @AHSN_YandH @CLAHRC_SY #AHSN Event

ww.yhahsn.org.uk@CLAHRC_LYB @YHANSNP @CLAHRC_SY #AHSN Event

www.clahrc-lyb.nihr.ac.uk www.yhahsn.org.uk www.clahrc-sy.nihr.ac.uk

@CLAHRC_LYB @AHSN_YandH @CLAHRC_SY #AHSN Event

• What are the current challenges in Transforming Health Care?

• How can research contribute to addressing these challenges?

ww.yhahsn.org.uk@CLAHRC_LYB @YHANSNP @CLAHRC_SY #AHSN Event

www.clahrc-lyb.nihr.ac.uk www.yhahsn.org.uk www.clahrc-sy.nihr.ac.uk

@CLAHRC_LYB @AHSN_YandH @CLAHRC_SY #AHSN Event

Driving Research Evidence into Practice

HOW CAN RESEARCH IMPROVE  QUALITY

EXAMPLES FROM MATERNAL & CHILD HEALTH

John Wright on behalf of the researchers and clinicians in the Maternal and Child Health CLAHRC

CLAHRC maternal and child health

• Develop communities of practice• Identify information needs• Establish accurate and reliable data collection• Link data to provide useful intelligence• Feedback timely and accurate data and evidence to

practitioners• Promote professional change

Bringing together researchers with practitioners from the NHS and Local Authorities to:

What difference does it make?• Improved detection of gestational diabetes: 2%-7%• Development of a regional congenital anomalies register

• Increase in Vitamin D supplementation: 10-90%• Improvement in smoking cessation support• Changes to the red book!• Informing national policy for child health outcomes• Evidence based computerised

prompts for GPs

How did we do it?

• Align research and practice priorities• Communities of practice – time and space• Quality improvement techniques• Strong partnership between NHS and universities• Strong public engagement

CLAHRC goes to school

ww.yhahsn.org.uk@CLAHRC_LYB

@YHANSNP @CLAHRC_SY

#AHSN Event

www.clahrc-lyb.nihr.ac.uk www.yhahsn.org.uk www.clahrc-sy.nihr.ac.uk

@CLAHRC_LYB

@AHSN_YandH

@CLAHRC_SY

#AHSN Event

Driving Research Evidence into Practice

ww.yhahsn.org.uk

Using evidence briefings to inform healthcare services

Paul Wilson & Duncan ChambersCentre for Reviews and Dissemination

University of York

@CLAHRC_LYB @YHANSNP @CLAHRC_SY #AHSN Eventwww.clahrc-lyb.nihr.ac.uk www.yhahsn.org.uk www.clahrc-sy.nihr.ac.uk

@CLAHRC_LYB @AHSN_YandH @CLAHRC_SY #AHSN Event

ww.yhahsn.org.uk

Renewed emphasis in NHS

• Health and Social Care Act embeds research as a core function of the NHS– Assist conduct– Promote use

• Unmanageable volume of research evidence– 20 million citations in PubMed – 75 RCTs published daily– 29,000 systematic reviews on DARE– 14,000 economic evaluations on NHS EED

www.clahrc-lyb.nihr.ac.uk www.yhahsn.org.uk www.clahrc-sy.nihr.ac.uk

@CLAHRC_LYB @AHSN_YandH @CLAHRC_SY #AHSN Event

ww.yhahsn.org.uk

CRD knowledge translation service

• Work with local decision makers (CLAHRC/ Non CLAHRC) to provide evidence informed answers to questions faced

• Briefings based on existing synthesised evidence– Systematic reviews (DARE, Cochrane)– Economic evaluations (NHS EED)– Guidelines (NICE)

• Highlight quality / strength of evidence, assess cost effectiveness, local applicability, implications relating to local service delivery, implementation and equity

www.clahrc-lyb.nihr.ac.uk www.yhahsn.org.uk www.clahrc-sy.nihr.ac.uk

@CLAHRC_LYB @AHSN_YandH @CLAHRC_SY #AHSN Event

ww.yhahsn.org.uk

www.clahrc-lyb.nihr.ac.uk www.yhahsn.org.uk www.clahrc-sy.nihr.ac.uk

@CLAHRC_LYB @AHSN_YandH @CLAHRC_SY #AHSN Event

ww.yhahsn.org.uk

Outputs to date

• 14 full briefings undertaken including:

– Inpatient rehabilitation services for the frail elderly – Non-pharmacological interventions for dementia– Tele-health– Drug treatments for patients with pulmonary hypertension– Integrated care pathways in mental health care settings– Nurse led endoscopy services– Alternatives to inpatient admission for adolescents with eating disorders

• Feedback positive, but service developmental

www.clahrc-lyb.nihr.ac.uk www.yhahsn.org.uk www.clahrc-sy.nihr.ac.uk

@CLAHRC_LYB @AHSN_YandH @CLAHRC_SY #AHSN Event

ww.yhahsn.org.uk

Future developments

• Formal evaluation funded by HSDR commencing 2013

• AHSN offers an opportunity to upscale service from local to regional

• AHSN Translating Research & Learning into Practice– Commitment to provide a bespoke evidence synthesis service to

support service planning and delivery

• Contribute to delivery of Health and Social Care Act obligations

www.clahrc-lyb.nihr.ac.uk www.yhahsn.org.uk www.clahrc-sy.nihr.ac.uk

@CLAHRC_LYB @AHSN_YandH @CLAHRC_SY #AHSN Event

ww.yhahsn.org.uk@CLAHRC_LYB @YHANSNP @CLAHRC_SY #AHSN Event

www.clahrc-lyb.nihr.ac.uk www.yhahsn.org.uk www.clahrc-sy.nihr.ac.uk

@CLAHRC_LYB @AHSN_YandH @CLAHRC_SY #AHSN Event

Driving Research Evidence into Practice

information absent from implementation/transformation

decision making: Part I - economicsCarl Thompson

Professor TRiP-LaB, University of York

when the costs of “changing behaviour” are included in the implementation of even “cost effective” technologies… Sometimes…It just isn’t “worth it”

“Ensuring this large scale adoption takes place is the task of every person working within the NHS and those accessing its services - we must all contribute$. ”

$www.institute.nhs.uk/innovation/innovation/introduction.html

£…..£££….???• Audit and feedback• Educational outreach• Literature/leaflets/passive

dissemination• Educational events• Academic detailing• Reminder systems• IT templates and decision

“support”…

[policy] cost effectiveness

impacted Patients*enefits/ptΔRxHealthB

impacted Patients*ΔRxCost/ptΔPCE

itealthBenefNetPolicyH

ostNetPolicyCΔPCE

CostIP

cf.Mason et al, JAMA 2001

9000

Estimated Proportion Undiagnosed vs. Modelled COPD Patients per GP Practice

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

0 100 200 300 400 500 600 700

Modelled COPD Patients per GP practice

Esti

mat

ed P

ropo

rtion

Und

iagn

osed

(%)

Estimated Proportion Undiagnosed (SPC P)

Average SPC C

SPC UCL = C+3SD

SPC LCL = C-3SD

2500 – 11000 “missing”

Example: “Opportunistic Case Finding” for COPD

• Evidence:

• Four person QI team 0.5 wte for 6 months ≈ £50000

• additional patients treated?

• 50 £23533/QALY• 100 £12170/QALY

QALYPatientQALY

Patient

PatientnefitRxHealthBe

PatientRxCost/806£

/044.0

/49.35£

/

/

For the AHSN

PCE

training

knowledge

dissemination

evaluation

ww.yhahsn.org.uk@CLAHRC_LYB @YHANSNP @CLAHRC_SY #AHSN Event

www.clahrc-lyb.nihr.ac.uk www.yhahsn.org.uk www.clahrc-sy.nihr.ac.uk

@CLAHRC_LYB @AHSN_YandH @CLAHRC_SY #AHSN Event

• What are the current challenges in Transforming Health Care?

• How can research contribute to addressing these challenges?