A5030923673- Primary Care and Health Outcomes
- Chronic Disease Management Strategies
- Health Systems, Economic Evaluations, Quality of Life
- Healthcare Policy and Management
- Telemedicine and Telehealth Implementation
- Geriatric Care and Nursing Homes
- Global Health Care Issues
- Frailty in Older Adults
- Interprofessional Education and Collaboration
- Health disparities and outcomes
- Emergency and Acute Care Studies
- Healthcare innovation and challenges
- Patient Satisfaction in Healthcare
- Palliative Care and End-of-Life Issues
- Clinical practice guidelines implementation
- Health Promotion and Cardiovascular Prevention
- Nutrition and Health in Aging
- Global Health Workforce Issues
- Medical Coding and Health Information
- Healthcare Quality and Management
- Health Services Management and Policy
- Migration, Health and Trauma
- Healthcare Systems and Technology
- Employment and Welfare Studies
- Healthcare cost, quality, practices
Health Foundation
2015-2021
Nuffield Trust
2010-2019
University of London
2015
London School of Hygiene & Tropical Medicine
2015
Medical Research Council
2011
Greater London Authority
1999
Imperial College London
1999
Middlesex University
1998
Edwards (United Kingdom)
1992-1993
Freeman Hospital
1992
BackgroundOlder people are increasing users of health care globally. We aimed to establish whether older with characteristics frailty and who at risk adverse health-care outcomes could be identified using routinely collected data.MethodsA three-step approach was used develop validate a Hospital Frailty Risk Score from International Statistical Classification Diseases Related Health Problems, Tenth Revision (ICD-10) diagnostic codes. First, we carried out cluster analysis identify group (≥75...
<b>Objective</b> To assess the effect of home based telehealth interventions on use secondary healthcare and mortality. <b>Design</b> Pragmatic, multisite, cluster randomised trial comparing with usual care, using data from routine administrative datasets. General practice was unit randomisation. We allocated practices a minimisation algorithm, did analyses by intention to treat. <b>Setting </b>179 general in three areas England. <b>Participants </b>3230 people diabetes, chronic obstructive...
Telehealth (TH) and telecare (TC) interventions are increasingly valued for supporting self-care in ageing populations; however, evaluation studies often report high rates of non-participation that not well understood. This paper reports from a qualitative study nested within large randomised controlled trial the UK: Whole System Demonstrator (WSD) project. It explores barriers to participation adoption TH TC perspective people who declined participate or withdrew trial. Qualitative...
<b>Objective</b> To examine the costs and cost effectiveness of telehealth in addition to standard support treatment, compared with treatment. <b>Design</b> Economic evaluation nested a pragmatic, cluster randomised controlled trial. <b>Setting</b> Community based intervention three local authority areas England. <b>Participants</b> 3230 people long term condition (heart failure, chronic obstructive pulmonary disease, or diabetes) were recruited into Whole Systems Demonstrator trial between...
<b>Objective</b> To assess the effect of second generation, home based telehealth on health related quality life, anxiety, and depressive symptoms over 12 months in patients with long term conditions. <b>Design</b> A study patient reported outcomes (the Whole Systems Demonstrator questionnaire study; baseline n=1573) was nested a pragmatic, cluster randomised trial trial, n=3230). General practice unit randomisation, compared usual care. Data were collected at baseline, four (short term),...
To develop an algorithm for identifying inpatients at high risk of re-admission to a National Health Service (NHS) hospital in England within 30 days discharge using information that can either be obtained from systems or the patient and their notes.Multivariate statistical analysis routinely collected episode statistics (HES) data logistic regression build predictive model. The model's performance was calculated bootstrapping.HES covering all NHS admissions England.The patients were...
To identify trends in emergency admissions for patients with clinical conditions classed as 'ambulatory care sensitive' (ACS) and assess if reductions might be due to improvements preventive care.Observational study of routinely collected hospital admission data from March 2001 April 2011. Admission rates were calculated at the population level using national estimates area residence.All National Health Service (NHS) hospitals England 2011 people residents England.Age-standardised each 27...
Summary Current demand for accountability and efficiency of healthcare organizations, combined with the greater availability routine data on clinical care outcomes, has led to an increased focus statistical methods in regulation. We consider three different regulatory functions which analysis plays a vital role: rating deciding whom inspect continuous surveillance arising problems. A common approach standardization based (possibly overdispersed) Z-scores is proposed, although specific tools...
To investigate organisational factors influencing the implementation challenges of redesigning services for people with long term conditions in three locations England, using remote care (telehealth and telecare). Case-studies sites forming UK Department Health's Whole Systems Demonstrator (WSD) Programme. Qualitative research techniques were used to obtain data from various sources, including semi-structured interviews, observation meetings over course programme prior its launch, document...
Abstract Background It is expected that increased demands on services will result from expanding numbers of older people with long-term conditions and social care needs. There significant interest in the potential for technology to reduce utilisation health these patient populations, including telecare (the remote, automatic passive monitoring changes an individual's condition or lifestyle) telehealth remote exchange data between a professional). The improve costs limited by lack rigorous...
to assess the impact of telecare on use social and health care. Part evaluation Whole Systems Demonstrator trial.
<h3>Background</h3> Telehealth is an emerging field of clinical practice but current UK health policy has not taken account the perceptions front-line healthcare professionals expected to implement it. <h3>Aim</h3> To investigate telehealth care for people with long-term conditions from perspective professional. <h3>Design and setting</h3> A qualitative study in three sites within (Kent, Cornwall, London Borough Newham) embedded Whole Systems Demonstrator evaluation, a large cluster...
Background Many health systems across the globe have introduced arrangements to deny payment for patients readmitted hospital as an emergency. The purpose of this study was develop exploratory categorisation based on likely causes readmission, and then assess prevalence these different types. Methods Retrospective analysis 82 million routinely collected National Health Service records in England (2004–2010) undertaken using anonymised linkage at person-level. Numbers 30-day readmissions were...
<b>Objectives</b> To develop a formula for allocating resources commissioning hospital care to all general practices in England based on the health needs of people registered each practice <b>Design</b> Multivariate prospective statistical models were developed which routinely collected electronic information from 2005-6 and 2006-7 individuals areas they lived was used predict their costs next year, 2007-8. Data included diagnoses recorded at any inpatient admission. Models random sample 5...
Introduction: In 2009, the English Department of Health appointed 16 integrated care pilots which aimed to provide better care. We report quantitative results from a multi-method evaluation six demonstration projects used risk profiling tools identify older people at emergency hospital admission, combined with intensive case management for identified as risk. The interventions focused mainly on delivery system redesign and improved clinical information systems, two key elements Wagner's...
Background: home-based telecare (TC) is utilised to manage risks of independent living and provide prompt emergency responses. This study examined the effect TC on health-related quality life (HRQoL), anxiety depressive symptoms over 12 months in patients receiving social care. Design: a participant-reported outcomes [the Whole Systems Demonstrator (WSD) Telecare Questionnaire Study; baseline n = 1,189] was nested pragmatic cluster-randomised trial (the WSD trial), held across three English...
This paper provides the results of a year-long evaluation large-scale integrated care pilot in north-west London. The aimed to integrate across primary, acute, community, mental health and social for people with diabetes and/or those aged 75+ through planning, multidisciplinary case reviews, information sharing project management support.
Purpose of the study: to examine costs and cost-effectiveness 'second-generation' telecare, in addition standard support care that could include 'first-generation' forms compared with telecare.
To test the performance of new variants models to identify people at risk an emergency hospital admission. We compared (1) impact using alternative data sources (hospital inpatient, A&E, outpatient and general practitioner (GP) electronic medical records) (2) effects local calibration on (3) choice population denominators.Multivariate logistic regressions person-level adding each set sequentially value additional variables denominators.5 Primary Care Trusts within England.1 836 099 aged...
Patients at high risk of emergency hospitalisation are particularly likely to experience fragmentation in care. The virtual ward model attempts integrate health and social care by offering multidisciplinary case management people predicted unplanned hospitalisation.
<b>Objectives</b> To test the effect of a telephone health coaching service (Birmingham OwnHealth) on hospital use and associated costs. <b>Design</b> Analysis person level administrative data. Difference-in-difference analysis was done relative to matched controls. <b>Setting</b> Community based intervention operating in large English city with industry. <b>Participants</b> 2698 patients recruited from local general practices before 2009 heart failure, coronary disease, diabetes, or chronic...
The Whole Systems Demonstrator was a large, pragmatic, cluster randomised trial that compared telehealth with usual care among 3,230 patients long-term conditions in three areas of England. Telehealth involved the regular transmission physiological information such as blood glucose to health professionals working remotely. We examined whether led changes glycosylated haemoglobin (HbA1c) subset type 2 diabetes. general practice electronic medical record used source on HbA1c. Effects HbA1c...
To assess the effect of routinely delivered home-based end-of-life care on hospital use at end life and place death.Retrospective analysis using matched controls administrative data.Community-based in England.29,538 people aged over 18 who received Marie Curie nursing support compared with 29,538 individually variables including: age, socioeconomic deprivation, prior use, number chronic conditions diagnostic history.Home-based by Nursing Service (MCNS), available to those did not receive...
Objective To identify the relative importance of factors influencing hospital use at end life. Design Retrospective cohort study person and health system effects on in past 12 months modelling differences admissions, bed days whether a died hospital. Setting Residents England for period 2009/2010 to 2011/2012 using Hospital Episodes Statistics (HES) data from all acute care hospitals funded by National Health Service (NHS). Participants 1 223 859 people registered with GP who (decedents)...