13,218 research outputs found
Reducing variation in hospital mortality for alcohol-related liver disease in North West England
Background Variations in emergency care quality for alcoholârelated liver disease (ARLD) have been highlighted. Aim To determine whether introduction of a regional quality improvement (QI) programme was associated with a reduction in potentially avoidable inpatient mortality. Method Retrospective observational cohort study using hospital administrative data spanning a 1âyear period before (2014/2015) and 3 years after a QI initiative at seven acute hospitals in North West England. The intervention included serial audit of a bundle of process metrics. An algorithm was developed to identify index (âfirstâ) emergency admissions for ARLD (n = 3887). We created a standardised mortality ratio (SMR) to compare relative mortality and regression models to examine riskâadjusted odds of death. Results In 2014/2015, three of seven hospitals had an SMR above the upper control limit (âoutliersâ). Adjusted odds of death for patients admitted to outlier hospitals was higher than nonâoutliers (OR 2.13, 95% CI 1.32â3.44, P = 0.002). Following the QI programme there was a stepâwise reduction in outliers (none in 2017/2018). Odds of death was 67% lower in 2017/2018 compared to 2014/2015 at original outlier hospitals, but unchanged at other hospitals. Process audit performance of outliers was worse than nonâoutliers at baseline, but improved after intervention. Conclusions There was a reduction in unexplained variation in hospital mortality following the QI intervention. This challenges the pessimism that is prevalent for achieving better outcomes for patients with ARLD. Notwithstanding the limitations of an uncontrolled observational study, these data provide hope that coâordinated efforts to drive adoption of evidenceâbased practice can save lives
Geographical variation in Hepatitis C-related severe liver disease and patient risk factors: A multicentre cross-sectional study
No abstract available
Alcohol-specific activity in hospitals in England
Alcohol-related harm is placing increasing demands on the NHS. At a time when unprecedented efficiencies need to be made by the NHS and local authorities, preventative action must be taken seriously. This analysis explores trends in alcohol-specific activity in hospitals due to alcohol poisoning and alcohol-related inpatient admissions by looking at six years of hospital activity data in England. The analysis also explores the use of hospital services before and after a diagnosis of alcohol-related liver disease and highlights opportunities for preventative action to reduce future alcohol-related harm in England
Integrated out-of-hours care arrangements in England: observational study of progress towards single call access via NHS Direct and impact on the wider health system
Objectives: To assess the extent of service integration achieved within general practice cooperatives and NHS Direct sites participating in the Department of Healthâs national âExemplar Programmeâ for single call access to out-of-hours care via NHS Direct. To assess the impact of integrated out-of-hours care arrangements upon general practice cooperatives and the wider health system (use of emergency departments, 999 ambulance services, and minor injuries units).
Design: Observational before and after study of demand, activity, and trends in the use of other health services.
Setting: Thirty four English general practice cooperatives with NHS Direct partners (âexemplarsâ) of which four acted as âcase exemplarsâ. Also 10 control cooperatives for comparison.
Main Outcome Measures: Extent of integration achieved (defined as the proportion of hours and the proportion of general practice patients covered by integrated arrangements), patterns of general practice cooperative demand and activity and trends in use of the wider health system in the first year.
Results: Of 31 distinct exemplars 21 (68%) integrated all out-of-hours call management by March 2004. Nine (29%) established single call access for all patients. In the only case exemplar where direct comparison was possible, cooperative nurse telephone triage before integration completed a higher proportion of calls with telephone advice than did NHS Direct afterwards (39% v 30%; p<0.0001). The proportion of calls completed by NHS Direct telephone advice at other sites was lower. There is evidence for transfer of demand from case exemplars to 999 ambulance services. A downturn in overall demand for care seen in two case exemplars was also seen in control sites.
Conclusion: The new model of out-of-hours care was implemented in a variety of settings across England by new partnerships between general practice cooperatives and NHS Direct. Single call access was not widely implemented and most patients needed to make at least two telephone calls to contact the service. In the first year, integration may have produced some reduction in total demand, but this may have been accompanied by shifts from one part of the local health system to another. NHS Direct demonstrated capability in handling calls but may not currently have sufficient capacity to support national implementation
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The Persistent Southern Disadvantage in Us Early Life Mortality, 1965â2014
Background: Recent studies of US adult mortality demonstrate a growing disadvantage among southern states. Few studies have examined long-term trends and geographic patterns in US early life (ages 1 to 24) mortality, ages at which key risk factors and causes of death are quite different than among adults. Objective: This article examines trends and variations in early life mortality rates across US states and census divisions. We assess whether those variations have changed over a 50-year time period and which causes of death contribute to contemporary geographic disparities. Methods: We calculate all-cause and cause-specific death rates using death certificate data from the Multiple Cause of Death files, combining public-use files from 1965â2004 and restricted data with state geographic identifiers from 2005â2014. State population (denominator) data come from US decennial censuses or intercensal estimates. Results: Results demonstrate a persistent mortality disadvantage for young people (ages 1 to 24) living in southern states over the last 50 years, particularly those located in the East South Central and West South Central divisions. Motor vehicle accidents and homicide by firearm account for most of the contemporary southern disadvantage in US early life mortality. Contribution: Our results illustrate that US children and youth living in the southern United States have long suffered from higher levels of mortality than children and youth living in other parts of the country. Our findings also suggest the contemporary southern disadvantage in US early life mortality could potentially be reduced with state-level policies designed to prevent deaths involving motor vehicles and firearms
The unavoidable costs of ethnicity : a review of evidence on health costs
This report was commissioned by the Advisory Committee on Resource Allocation (ACRA), and prepared
by the Centre for Health Services Studies (CHESS) and the Centre for Research in Ethnic Relations
(CRER) at the University of Warwick. The NHS Executive does not necessarily assent to the factual
accuracy of the report, nor necessarily share the opinions and recommendations of the authors.
The study reviews the evidence concerning the degree to which the presence of populations of minority
ethnic origin was associated with âunavoidable additional costsâ in health service delivery. While local
health authorities retail full autonomy in their use of funds allocated to them under the Hospital and
Community Health Services formula, the size of that budget is governed by a set of weightings applied to
their population, to allow for factors known to influence levels of need, and the costs of providing services.
The study began by considering the definitions used in describing âethnicityâ and ethnic groups in relevant
medical and social policy literature. It is clear that no fixed set of terms can be adopted, and that flexibility
is required to respond to social changes. The terms used in the 1991 Census, with additions to allow for
local and contemporary developments, provide a suitable baseline but require additional information on
religion language and migration history for clinical and health service delivery planning.
There have been notable developments in health service strategy to meet the needs of black and minority
ethnic groups which have been encouraged by good practice guidelines and local initiatives. Together with
research into epidemiology and ethnic monitoring of services, these have enlarged understanding of the
impact of diversity. A conceptual model is developed which explores the potential for such diversity to lead
to variations in the cost of providing health services to a multi-ethnic population.
The research team reviewed the existing published evidence relating to ethnic health and disease treatment
in medical, social science, academic and practitioner literature, using conventional techniques. Additional
evidence was located through trawls of âgreyâ literature in specialist collections, and through contacting all
English health districts with a request for information. A number of authorities and trusts provided written
and oral evidence, and a bibliography of key materials is provided.
Key issues considered include the need for and use of, interpreter and translation services, the incidence of
âethnically-specificâ disease, and variations in the prevalence and cost of treating âcommonâ conditions in
minority ethnic populations. Sources of variation are discussed, and a âscopingâ approach adopted to
explore the extent to which these variations could be adequately modelled. It is clear that while some
additional costs can be identified, and seen to be unavoidable, there are other areas where the presence of
minority populations may lead to lessened pressures on budgets, or where provision of âethnic-specificâ
facilities may be alternative to existing needs.
The literature provides a range of estimates which can be used in a modelling exercise, but is deficient in
many respects, particularly in terms of precise costs associated with procedure and conditions, or in
associating precise and consistent categories of ethnic group with epidemiological and operational service
provision data. Certain other activities require funding to set them up, and may not be directly related to
population size. There is considerable variation in the approaches adopted by different health authorities,
and many services are provided by agencies not funded by NHS budgets. The study was completed before
the announcement of proposed changes in health service commissioning which may have other implications
for ethnic diversity.
The presence of minorities is associated with the need to provide additional services in respect of
interpreting and translation, and the media of communication.
In order to achieve clinical effectiveness, a range of advocacy support facilities or alternative models of
provision seem to be desirable.
Ethnic diversity requires adaptation and additional evidence in order to inform processes of consultation
and commissioning.
Minority populations do create demands for certain additional specific clinical services not required by the
bulk of the majority population: it is not yet clear to what extent the reverse can be stated since research on
âunder-useâ is less well developed.
Some variations in levels of need, particularly those relating to established clinical difference in
susceptibility or deprivation, are already incorporated in funding formulae although it is not clear how far
the indicators adequately reflect these factors.
Costs are not necessarily simply related to the size of minority populations.
The provision of services to meet minority needs is not always a reflection of their presence, but has
frequently depended upon the provision of additional specific funds.
There is a consensus that the NHS research and development strategy should accept the need for more work
to establish the actual levels of need and usage of service by ethnic minority groups, and that effort should
be made to use and improve the growing collection of relevant information through ethnic monitoring
activities.
A variety of modelling techniques are suggested, and can be shown to have the potential to provide
practical guidance to future policy in the field.
Current data availability at a national or regional scale is inadequate to provide estimates of the âadditional
costs of ethnicityâ but locally collected data and the existence of relevant policy initiatives suggest that a
focused study in selected districts would provide sufficiently robust information to provide reliable
estimates.
The review has demonstrated that there are costs associated with the presence of minority ethnic groups in
the population which can be shown to be unavoidable and additional, but that others are either âdesirableâ or
âalternativeâ. It would be wrong to assume that all cost pressures of this nature are in the same direction.
Our study has drawn attention to deficiencies in data collection and budgeting which may hinder
investigation of the effectiveness of the service in general. The process of drawing attention to ethnic
minority needs itself leads to developments in services which are functional and desirable for the majority
population
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