A5015979075- Primary Care and Health Outcomes
- Healthcare Policy and Management
- Acute Ischemic Stroke Management
- Stroke Rehabilitation and Recovery
- Healthcare Systems and Reforms
- Chronic Disease Management Strategies
- Global Health Care Issues
- Diabetes Treatment and Management
- Health Systems, Economic Evaluations, Quality of Life
- Diabetes Management and Education
- Clinical practice guidelines implementation
- Resilience and Mental Health
- Diabetes, Cardiovascular Risks, and Lipoproteins
- Healthcare Systems and Technology
- Cerebrovascular and Carotid Artery Diseases
- Appendicitis Diagnosis and Management
- Metabolism, Diabetes, and Cancer
- Diabetes Management and Research
- Agricultural risk and resilience
- Cardiac, Anesthesia and Surgical Outcomes
- Healthcare Systems and Practices
- Advanced Causal Inference Techniques
- Telemedicine and Telehealth Implementation
- Education for Peace and Conflict Resolution
- Geriatric Care and Nursing Homes
London School of Hygiene & Tropical Medicine
2015-2025
Imperial College London
2020-2024
St Mary's Hospital
2023
Faculty of Public Health
2022
University of Manchester
2017-2020
Manchester Academic Health Science Centre
2019-2020
Universidad de Londres
2015
University of London
2015
There is increasing awareness among researchers and policymakers of the potential for healthcare interventions to have consequences beyond those initially intended. These unintended or "spillover effects" result from complex features organisation delivery can either increase decrease overall effectiveness. Their influence has important design evaluation implementation strategies decision-making. However, consideration spillovers remains partial unsystematic. We develop a comprehensive...
Abstract Objective To compare the effectiveness of three commonly prescribed oral antidiabetic drugs added to metformin for people with type 2 diabetes mellitus requiring second line treatment in routine clinical practice. Design Cohort study emulating a comparative trial (target trial). Setting Linked primary care, hospital, and death data England, 2015-21. Participants 75 739 adults who initiated sulfonylurea, DPP-4 inhibitor, or SGLT-2 inhibitor metformin. Main outcome measures Primary...
To create a classification system based on stroke-related impairments.All adults with stroke admitted for at least 72 hours in England, Wales and Northern Ireland from July 2013 to 2015 extracted the Sentinel Stroke National Audit Programme.Impairments were defined using Institute of Health Scale scores admission. Common combinations impairments identified geometric coding expert knowledge. Validity was assessed standard descriptive statistics report compare patients' characteristics,...
Summary The effectiveness of emergency surgery vs. non‐emergency strategies for admissions with acute appendicitis, gallstone disease, diverticular abdominal wall hernia or intestinal obstruction is unknown. Data on adult patients from 2010 to 2019 at 175 National Health Service hospitals in England were extracted the Hospital Episode Statistics database. Cohort sizes were: 268,144 (appendicitis); 240,977 (gallstone disease); 138,869 (diverticular 106,432 (hernia); and 133,073 (intestinal...
To assess any disparities in the initiation of second-line antidiabetic treatments prescribed among people with type 2 diabetes mellitus (T2DM) England according to ethnicity and social deprivation level.This cross-sectional study used linked primary (Clinical Practice Research Datalink) secondary care data (Hospital Episode Statistics), Index Multiple Deprivation (IMD). We included aged 18 years or older T2DM who intensified oral medication between 2014 2020 investigate treatment...
To understand why most stroke patients receive little therapy. We investigated the factors associated with amount of therapy delivered.Data regarding adults admitted to hospital for at least 72 hours (July 2013-July 2015) were extracted from UK's Sentinel Stroke National Audit Programme. Descriptive statistics and multilevel mixed effects regression models explored that influenced received while adjusting confounding.Of 94,905 in study cohort (mean age: 76 (SD: 13.2) years, 78% had a mild or...
Abstract Aims To compare long‐term complications for people with type 2 diabetes mellitus (T2DM) following second‐line treatment in routine practice sulphonylureas (SU), dipeptidyl peptidase‐4 inhibitors (DPP4i), or sodium‐glucose co‐transporter‐2 (SGLT2i) added to metformin. Materials and Methods We used the RAPIDS microsimulation model predict over 5 years after initiation. combined information on ‘real‐world’ duration England from Clinical Practice Research Datalink evidence effectiveness...
Objetivos. Determinar el impacto del Seguro Popular (SPS) en los gastos catastróficos y empobrecedores de hogares la protección financiera sistema salud México. Material métodos. Se aplicó método pareo por puntaje propensión sobre afiliación al SPS se determinó efecto atribuible gasto salud. hizo uso Encuesta Nacional Ingresos Gastos Hogares (ENIGH) 2004 a 2012, Instituto Nacional Estadística Geografía. Resultados. El tiene un significativo reductor probabilidad sufrir empobrecedores. En lo...
Worldwide, the high prevalence of multiple chronic conditions amongst older population has led to increased utilisation health care and rising associated costs, becoming a major public concern. Hearing, vision cognitive disorders are common Europeans recent studies have documented its co-occurrence. While it been shown separately that suffering either mental or sensory (hearing vision) impairments is with higher utilisation, association between interaction these received little attention in...
Background Electronic health records (EHRs) offer opportunities for comparative effectiveness research to inform decision making. However, provide useful evidence, these studies must address confounding and treatment effect heterogeneity according unmeasured prognostic factors. Local instrumental variable (LIV) methods can help challenges, but have yet be applied EHR data. This article critically examines a LIV approach evaluate the cost-effectiveness of emergency surgery (ES) common acute...
To estimate the financial and health burden of diabetic ambulatory care sensitive hospitalisations (ACSH) in Mexico during 2001-2011.We identified ACSH due to complications general hospitals run by local ministries estimated their cost using diagnostic related groups. The estimation assumes that patients would not have experienced if they had received appropriate primary computes associated Disability-Adjusted Life Years (DALYs).The increased 125% real terms 2010 accounted for 4.2% total...
The prevalence of diabetes among adults in Mexico has increased markedly from 6.7 % 1994 to 14.7 2015. Although the main diabetic complications can be prevented or delayed with timely and effective primary care, a high percentage patients have developed them imposing an important preventable burden on Mexican society health system. This paper estimates financial caused by potentially hospitalisations due hospitals operated largest social security institution Latin America, Institute Social...
Background Therapy is key to effective stroke care, but many patients receive little. Objectives To understand how therapy delivered in England, Wales and Northern Ireland, which factors are associated with dose, outcome resource use. Design Secondary analysis of the Sentinel Stroke National Audit Programme, using standard descriptive statistics multilevel mixed-effects regression models, while adjusting for all known measured confounders. Setting services Ireland. Participants A total...
Background Evidence is required on the clinical effectiveness and cost-effectiveness of emergency surgery compared with non-emergency strategies (including medical management, non-surgical procedures elective surgery) for patients admitted to hospital common acute gastrointestinal conditions. Objectives We aimed evaluate relative (1) two (i.e. vs. strategies) five conditions presenting as admissions; (2) (3) alternative specific patient subgroups. Methods The records adults emergencies...
Better management of long-term conditions remains a policy priority, with focus on improving outcomes and reducing use expensive hospital services. A number interventions have been tested, but many failed to show benefit in rigorous comparative research. In 2016, the NHS Test Beds scheme was launched implement test combining digital technologies pathway redesign routine health care settings, each intervention comprising multiple innovations better realise from their 'combinatorial' effect....
Methods have been developed for transporting evidence from randomised controlled trials (RCTs) to target populations. However, these approaches allow only differences in characteristics observed the RCT and real-world data (overt heterogeneity). These do not recognise heterogeneity of treatment effects (HTE) according unmeasured (essential We use a trial design apply local instrumental variable (LIV) approach electronic health records Clinical Practice Research Datalink, examine both forms...
To map and describe how patients pass through stroke services.Data from 94,905 (July 2013-July 2015) who were still inpatients 72 hours after hospital admission extracted a national register used to identify the routes took community services. We sought categorize these iterative consultations with clinical experts patient characteristics, therapy provision, outcomes costs within each category.We identified 874 defined by type of admitting team subsequent transfer history. consolidated into...
Health systems around the world are aiming to improve integration of health and social care services deliver better for patients. Existing evaluations have focused exclusively on impact outcomes found little effect. That suggests need take a step back ask whether integrated programmes actually lead greater clinical indeed is associated with improved outcomes. We propose mediation analysis approach address these two fundamental questions when evaluating programmes. illustrate our by...
Objective ‘More is better’ a recognised mantra within stroke therapy, however, this has been developed in patients receiving long term rehabilitation. We investigated the relationship between amount of therapy received (from therapists and psychologists) key patient outcomes during inpatient care. Design A secondary analysis data from prospective cohort study was performed. Multilevel mixed models adjusting for measured confounders (eg, severity), explored dose (average minutes per day stay)...
Introduction & Objective: Guidelines now rely on studies using routinely-collected clinical data to emulate a ‘target trial’, hypothetical randomized controlled trial (RCT) one would wish do. A key question remains what drug add metformin improve glycemic control in people with type 2 diabetes (T2D). To inform care for excluded from RCTs, we developed target comparing add-on therapy dipeptidyl peptidase-4 inhibitors (DPP4) vs. sulfonylureas (SU), relevant choice many settings. We used an...