An independent evaluation of the NHS Modernisation Agency's 'Modernising Endoscopy Services' project using routinely collected, service-related endoscopy data.

Aim: To independently evaluate the NHS Modernisation Agency’s “Modernising Endoscopy Services” (MES) project using routinely collected, service-related endoscopy data.Methods: A random selection of 10 sites who had participated in the MES project (called MES sites) were compared to a random selection of 10 sites who were unsuccessful applicants for the MES project but had indicated their intention to redesign independently (called Non-MES sites). Data on Referral numbers, Number of patients waiting, Number of lost appointment slotsand Activity werecollected from all 20 sites for eight specific time periods ranging from January 2003 to April 2006 to evaluate the endoscopy services of MES and Non-MES sites and to compare both site types at specific points in time using various statistical tests. Activitydata were validated where appropriate using an equivalent HES dataset. Details of innovations introduced were collected to explore possible trends.Results: Data were not routinely collected by endoscopy units. NHS Trust datasets were subsequently included to ensure a full dataset for analysis. The accuracy of the Activitydata was successfully validated. There were relatively few statistically significant results to report. Consequently, this study found that the MES project did not significantly improve the endoscopy services of the MES sites over time. It also found that there was no significant difference between the MES sites and the Non-MES sites in the improvement of their endoscopy services over time and that the Non-MES sites appeared to implement changes that led to improvements to their services, although they were not statistically significant.Conclusions: Data was not routinely collected by most NHS endoscopy units participating in this study. Based on the data analysed, the MES project did not appear to have significantly improved NHS endoscopy services over and above what could have been achieved independently with only the intention to redesig

An independent evaluation of the modernization of NHS endoscopy services in England: data poverty and no improvement

Rationale, aims and objectives The Modernising Endoscopy Services (MES) programme introduced a focussed modernization drive and data collection regime to English NHS endoscopy services. We independently evaluated the MES programme by comparing routinely collected, service-related endoscopy data from sites that participated in the MES programme and sites that did not. Methods A random selection of 10 endoscopy units who had participated in the MES programme (intervention sites) were compared with a random selection of 10 endoscopy units who redesigned their services independently (control sites). Data on demand, numbers waiting, activity and cancellations were collected for eight time points between January 2003 and April 2006. Data were aggregated into intervention and control groups for statistical analysis using a two-way analysis of variance. Activity data were validated using an equivalent Hospital Episode Statistics dataset. Results Data were not routinely collected by 11 of 19 endoscopy units. Trust-held datasets were subsequently included to address problems with data availability. The accuracy of the Activity data was successfully validated. Statistical analysis of the data showed that neither the intervention group nor the control group were able to significantly improve their services over time. There was also no significant difference between the intervention group and the control group in the improvement of their endoscopy services at any point time. Conclusions Based on the data collected, the intervention programme did not significantly improve NHS endoscopy services in England over and above what could have been achieved independently with only the intention to redesign

MATRICS: A Method for Aggregating The Reporting of Interventions in Complex Studies

There are few rigorous methods for combining qualitative and quantitative findings from studies with complex interventions using multiple research methods and giving appropriate weight to each without introducing bias to the overall conclusions.We developed a Method for Aggregating The Reporting of Interventions in Complex Studies (MATRICS) for the ENIGMA study (Evaluating Innovations in Gastroenterology by the NHS Modernisation Agency) – a multi-centre, mixed-methods study to evaluate the impact of the Modernising Endoscopy Services programme [1], funded by the UK National Institute for Health Research (NIHR SDO ref 08/1304/46)

Randomised controlled trial. Comparison Of iNfliximab and ciclosporin in STeroid Resistant Ulcerative Colitis:Trial design and protocol (CONSTRUCT)

Introduction: Many patients with ulcerative colitis (UC) present with acute exacerbations needing hospital admission. Treatment includes intravenous steroids but up to 40% of patients do not respond and require emergency colectomy. Mortality following emergency colectomy has fallen, but 10% of patients still die within 3 months of surgery. Infliximab and ciclosporin, both immunosuppressive drugs, offer hope for treating steroid-resistant UC as there is evidence of their short-term effectiveness. As there is little long-term evidence, this pragmatic randomised trial, known as Comparison Of iNfliximab and ciclosporin in STeroid Resistant Ulcerative Colitis: a Trial (CONSTRUCT), aims to compare the clinical and cost-effectiveness of infliximab and ciclosporin for steroid-resistant UC. Methods and analysis: Between May 2010 and February 2013, 52 UK centres recruited 270 patients admitted with acute severe UC who failed to respond to intravenous steroids but did not need surgery. We allocated them at random in equal proportions between infliximab and ciclosporin.The primary clinical outcome measure is quality-adjusted survival, that is survival weighted by Crohn's and Colitis Questionnaire (CCQ) participants' scores, analysed by Cox regression. Secondary outcome measures include: the CCQ—an extension of the validated but community-focused UK Inflammatory Bowel Disease Questionnaire (IBDQ) to include patients with acute severe colitis and stoma; two general quality of life measures—EQ-5D and SF-12; mortality; survival weighted by EQ-5D; emergency and planned colectomies; readmissions; incidence of adverse events including malignancies, serious infections and renal disorders; disease activity; National Health Service (NHS) costs and patient-borne costs. Interviews investigate participants’ views on therapies for acute severe UC and healthcare professionals’ views on the two drugs and their administration. Ethics and dissemination: The Research Ethics Committee for Wales has given ethical approval (Ref. 08/MRE09/42); each participating Trust or Health Board has given NHS Reseach & Development approval. We plan to present trial findings at international and national conferences and publish in high-impact peer-reviewed journals.11 page(s

Method for Aggregating The Reporting of Interventions in Complex Studies (MATRICS): successful development and testing

Objectives: To develop a tool for the accurate reporting and aggregation of findings from each of the multiple methods used in a complex evaluation in an unbiased way. Study Design and Setting: We developed a Method for Aggregating The Reporting of Interventions in Complex Studies (MATRICS) within a gastroenterology study [Evaluating New Innovations in (the delivery and organisation of) Gastrointestinal (GI) endoscopy services by the NHS Modernisation Agency (ENIGMA)]. We subsequently tested it on a different gastroenterology trial [Multi-Institutional Nurse Endoscopy Trial (MINuET)]. We created three layers to define the effects, methods, and findings from ENIGMA. We assigned numbers to each effect in layer 1 and letters to each method in layer 2. We used an alphanumeric code based on layers 1 and 2 to every finding in layer 3 to link the aims, methods, and findings. We illustrated analogous findings by assigning more than one alphanumeric code to a finding. We also showed that more than one effect or method could report the same finding. We presented contradictory findings by listing them in adjacent rows of the MATRICS. Results: MATRICS was useful for the effective synthesis and presentation of findings of the multiple methods from ENIGMA. We subsequently successfully tested it by applying it to the MINuET trial. Conclusion: MATRICS is effective for synthesizing the findings of complex, multiple-method studies.6 page(s

Unmeasured improvement work: the lack of routinely collected, service-related data in NHS endoscopy units in England involved in "modernisation"

Contains fulltext : 70532.pdf (publisher's version ) (Open Access)BACKGROUND: The availability of routinely collected service-related endoscopy data from NHS endoscopy units has never been quantified. METHODS: This retrospective observational study asked 19 endoscopy units to submit copies of all in-house, service-related endoscopy data that had been routinely collected by the unit - Referral numbers, Activity, Number of patients waiting and Number of lost slots. Nine of the endoscopy units had previously participated in the Modernising Endoscopy Services (MES) project during 2003 to redesign their endoscopy services. These MES sites had access to additional funding and data collection software. The other ten (Control sites) had modernised independently. All data was requested in two phases and corresponded to eight specific time points between January 2003 and April 2006. RESULTS: Only eight of 19 endoscopy units submitted routinely collected, service-related data. Another site's data was collected specifically for the study. A further two units claimed to routinely collect service-related data but did not submit any to the study. The remaining eight did not collect any service-related endoscopy data routinely and liaised with their Trust for data. Of the eight sites submitting service-related data, only three were MES project sites. Of these three, the data variables collected were limited and none collected the complete set of endoscopy data variables requested. Of the other five sites, two collected all four endoscopy data types. Data for the three MES project sites went back as far as January 2003, whilst the five Control sites were only able to submit data from December 2003 onwards. CONCLUSION: There was a lack of service-related endoscopy data routinely collected by the study sites, especially those who had participated in the MES project. Without this data, NHS endoscopy services cannot have a true understanding of their services, cannot identify problems and cannot measure the impact of any changes. With the increasing pressures placed on NHS endoscopy services, the need to effectively inform redesign plans is paramount. We recommend the compulsory collection of service-related endoscopy data by all NHS endoscopy units using a standardised format with rigorous guidelines

Mortality following Stroke, the Weekend Effect and Related Factors: Record Linkage Study

Increased mortality following hospitalisation for stroke has been reported from many but not all studies that have investigated a 'weekend effect' for stroke. However, it is not known whether the weekend effect is affected by factors including hospital size, season and patient distance from hospital.To assess changes over time in mortality following hospitalisation for stroke and how any increased mortality for admissions on weekends is related to factors including the size of the hospital, seasonal factors and distance from hospital.A population study using person linked inpatient, mortality and primary care data for stroke from 2004 to 2012. The outcome measures were, firstly, mortality at seven days and secondly, mortality at 30 days and one year.Overall mortality for 37 888 people hospitalised following stroke was 11.6% at seven days, 21.4% at 30 days and 37.7% at one year. Mortality at seven and 30 days fell significantly by 1.7% and 3.1% per annum respectively from 2004 to 2012. When compared with week days, mortality at seven days was increased significantly by 19% for admissions on weekends, although the admission rate was 21% lower on weekends. Although not significant, there were indications of increased mortality at seven days for weekend admissions during winter months (31%), in community (81%) rather than large hospitals (8%) and for patients resident furthest from hospital (32% for distances of >20 kilometres). The weekend effect was significantly increased (by 39%) for strokes of 'unspecified' subtype.Mortality following stroke has fallen over time. Mortality was increased for admissions at weekends, when compared with normal week days, but may be influenced by a higher stroke severity threshold for admission on weekends. Other than for unspecified strokes, we found no significant variation in the weekend effect for hospital size, season and distance from hospital