Learning health systems need to bridge the ‘two cultures’ of clinical informatics and data science

Background UK health research policy and plans for population health management are predicated upon transformative knowledge discovery from operational 'Big Data'. Learning health systems require not only data, but feedback loops of knowledge into changed practice. This depends on knowledge management and application, which in turn depends upon effective system design and implementation. Biomedical informatics is the interdisciplinary field at the intersection of health science, social science and information science and technology that spans this entire scope. Issues In the UK, the separate worlds of health data science (bioinformatics, 'Big Data') and effective healthcare system design and implementation (clinical informatics, 'Digital Health') have operated as 'two cultures'. Much National Health Service and social care data is of very poor quality. Substantial research funding is wasted on 'data cleansing' or by producing very weak evidence. There is not yet a sufficiently powerful professional community or evidence base of best practice to influence the practitioner community or the digital health industry. Recommendation The UK needs increased clinical informatics research and education capacity and capability at much greater scale and ambition to be able to meet policy expectations, address the fundamental gaps in the discipline's evidence base and mitigate the absence of regulation. Independent evaluation of digital health interventions should be the norm, not the exception. Conclusions Policy makers and research funders need to acknowledge the existing gap between the 'two cultures' and recognise that the full social and economic benefits of digital health and data science can only be realised by accepting the interdisciplinary nature of biomedical informatics and supporting a significant expansion of clinical informatics capacity and capability.</p

High health gain patients with asthma:a cross-sectional study analysing national Scottish data sets

Studies have shown that a small proportion of patients have particularly high needs and are responsible for disproportionally high disease burden. Estimates suggest that 2–5% of patients are high users of healthcare for their health gain. Such patients in Scotland are referred to as high health gain (HHG) patients. We wanted to investigate if there were HHG individuals with asthma in Scotland. We analysed data from the Scottish Health Survey (2010–11), and primary and National Health Survey (NHS) secondary healthcare and administrative data sets (2011–12). In all, 1,379,690 (26.0%) and 836,135 (15.8%) people reported to have ever had and currently have symptoms suggestive of asthma, respectively; 369,868 (7.0%) people reported current symptomatic clinician-diagnosed asthma. 310,050 (5.6%) people had clinician-reported-diagnosed asthma; there were 289,120 nurse consultations, 215,610 GP consultations, 9235 accident and emergency visits (0.2% people), 8263 ambulance conveyances (0.2% people), 7744 inpatient episodes (0.1% people), 3600 disability allowance claims (0.1% people), 187 intensive care unit (ICU) episodes and 94 deaths from asthma. From our study a maximum of about 9.4% of asthma patients (n = 29,145), which is 0.5% of the Scottish population, and from the National Review of Asthma Deaths’ estimate (10% hospitalised), a minimum of nine people had severe asthma attacks that needed acute hospital attendance/admission. We found that although a high proportion of the Scottish population had symptoms suggestive of asthma and clinician diagnosed asthma, only a small proportion of asthma patients experienced exacerbations that were severe enough to warrant hospital attendance/admission in any given year. Developing risk prediction models to identify these HHG patients has the potential to both improve health outcomes while substantially reducing healthcare expenditure

Ten years of asthma admissions to adult critical care units in England and Wales

OBJECTIVES: To describe the patient demographics, outcomes and trends of admissions with acute severe asthma admitted to adult critical care units in England and Wales. DESIGN: 10-year, retrospective analysis of a national audit database. SETTING: Secondary care: adult, general critical care units in the UK. PARTICIPANTS: 830 808 admissions to adult, general critical care units. PRIMARY AND SECONDARY OUTCOME MEASURES: Demographic data including age and sex, whether the patient was invasively ventilated or not, length of stay (LOS; both in the critical care unit and acute hospital), survival (both critical care unit and acute hospital) and time trends across the 10-year period. RESULTS: Over the 10-year period, there were 11 948 (1.4% of total) admissions with asthma to adult critical care units in England and Wales. Among them 67.5% were female and 32.5% were male (RR F:M 2.1; 95% CI 2.0 to 2.1). Median LOS in the critical care unit was 1.8 days (IQR 0.9–3.8). Median LOS in the acute hospital was 7 days (IQR 4–14). Critical care unit survival rate was 95.5%. Survival at discharge from hospital was 93.3%. There was an increase in admissions to adult critical care units by an average of 4.7% (95% CI 2.8 to 6.7)/year. CONCLUSIONS: Acute asthma represents a modest burden of work for adult critical care units in England and Wales. Demographic patterns for admission to critical care unit mirror those of severe asthma in the general adult community. The number of critical care admissions with asthma are rising, although we were unable to discern whether this represents a true increase in the incidence of acute asthma or asthma severity

Asthma in paediatric intensive care in England residents:observational study

Despite high prevalence of asthma in children in the UK, there were no prior report on asthma admissions in paediatric intensive care units (PICU). We investigated the epidemiology and healthcare resource utilisation in children with asthma presenting to PICUs in England. PICANet, a UK national PICU database, was queried for asthma as the primary reason for admission, of children resident in England from April 2006 until March 2013. There were 2195 admissions to PICU for a median stay of 1.4 days. 59% were males and 51% aged 0–4 years. The fourth and fifth most deprived quintiles represented 61% (1329) admissions and 73% (11) of the 15 deaths. Deaths were most frequent in 10–14 years age (n = 11, 73%), with no deaths in less than 5 years age. 38% of admissions (828/2193) received invasive ventilation, which was more frequent with increasing deprivation (13% (108/828) in least deprived to 31% (260/828) in most deprived) and with decreasing age (0–4-year-olds: 49%, 409/828). This first multi-centre PICU study in England found that children from more deprived neighbourhoods represented the majority of asthma admissions, invasive ventilation and deaths in PICU. Children experiencing socioeconomic deprivation could benefit from enhanced asthma support in the community

The Impact of Telehealthcare on the Quality and Safety of Care:A Systematic Overview

<div><p>Background</p><p>Telehealthcare involves the use of information and communication technologies to deliver healthcare at a distance and to support patient self-management through remote monitoring and personalised feedback. It is timely to scrutinise the evidence regarding the benefits, risks and costs of telehealthcare.</p><p>Methods and Findings</p><p>Two reviewers searched for relevant systematic reviews published from January 1997 to November 2011 in: The Cochrane Library, MEDLINE, EMBASE, LILACS, IndMed and PakMed. Reviewers undertook independent quality assessment of studies using the Critical Appraisal Skills Programme (CASP) tool for systematic reviews. 1,782 review articles were identified, from which 80 systematic reviews were selected for inclusion. These covered a range of telehealthcare models involving both synchronous (live) and asynchronous (store-and-forward) interactions between provider and patients. Many studies showed no differences in outcomes between telehealthcare and usual care. Several reviews highlighted the large number of short-term (<12 months) feasibility studies with under 20 participants. Effects of telehealthcare on health service indicators were reported in several reviews, particularly reduced hospitalisations. The reported clinical effectiveness of telehealthcare interventions for patients with long-term conditions appeared to be greatest in those with more severe disease at high-risk of hospitalisation and death. The failure of many studies to adequately describe the intervention makes it difficult to disentangle the contributions of technological and human/organisational factors on the outcomes reported. Evidence on the cost-effectiveness of telehealthcare remains sparse. Patient safety considerations were absent from the evaluative telehealthcare literature.</p><p>Conclusions</p><p>Policymakers and planners need to be aware that investment in telehealthcare will not inevitably yield clinical or economic benefits. It is likely that the greatest gains will be achieved for patients at highest risk of serious outcomes. There is a need for longer-term studies in order to determine whether the benefits demonstrated in time limited trials are sustained.</p></div

The epidemiology, healthcare and societal burden and costs of asthma in the UK and its member nations: analyses of standalone and linked national databases

Background There are a lack of reliable data on the epidemiology and associated burden and costs of asthma. We sought to provide the first UK-wide estimates of the epidemiology, healthcare utilisation and costs of asthma. Methods We obtained and analysed asthma-relevant data from 27 datasets: these comprised national health surveys for 2010–11, and routine administrative, health and social care datasets for 2011–12; 2011–12 costs were estimated in pounds sterling using economic modelling. Results The prevalence of asthma depended on the definition and data source used. The UK lifetime prevalence of patient-reported symptoms suggestive of asthma was 29.5 % (95 % CI, 27.7–31.3; n = 18.5 million (m) people) and 15.6 % (14.3–16.9, n = 9.8 m) for patient-reported clinician-diagnosed asthma. The annual prevalence of patient-reported clinician-diagnosed-and-treated asthma was 9.6 % (8.9–10.3, n = 6.0 m) and of clinician-reported, diagnosed-and-treated asthma 5.7 % (5.7–5.7; n = 3.6 m). Asthma resulted in at least 6.3 m primary care consultations, 93,000 hospital in-patient episodes, 1800 intensive-care unit episodes and 36,800 disability living allowance claims. The costs of asthma were estimated at least £1.1 billion: 74 % of these costs were for provision of primary care services (60 % prescribing, 14 % consultations), 13 % for disability claims, and 12 % for hospital care. There were 1160 asthma deaths. Conclusions Asthma is very common and is responsible for considerable morbidity, healthcare utilisation and financial costs to the UK public sector. Greater policy focus on primary care provision is needed to reduce the risk of asthma exacerbations, hospitalisations and deaths, and reduce costs