|Research Project Summaries for Potential|
|Implementation from both CLAHRC NWC & CLAHRCs NATIONALLY|
|Important Information for CLAHRC NWC Partners
|This online version can be search by the following Key Words.|
|Clinical and Non-Clinical Terms||Partner Organisations|
|Cancer||Aintree University Hospital NHS Foundation Trust||Liverpool City Council|
|Cardiovascular||Alder Hey Children`s NHS Foundation Trust||Liverpool Health Partners|
|Children & Young People||Blackburn with Darwen Clinical Commissioning Group||Liverpool Heart and Chest Hospital NHS Foundation Trust|
|Congenital Disorders||Blackburn with Darwen Council||Liverpool Womens Hospital NHS Foundation Trust|
|Drug Management||Blackpool Council||Mersey Care NHS Foundation Trust|
|Elderly Medicine||Blackpool Teaching Hospitals NHS Foundation trust||NHS East Lancashire Clinical Commissioning Group|
|General Practice (& Community Service Delivery)||Cheshire West and Chester Council||NHS Liverpool Clinical Commissioning Group|
|Health Inequalities||Cheshire and Wirral Partnership NHS Foundation Trust||NHS Southport and Formby Clinical Commissioning Group|
|Infection||Clatterbridge Cancer Centre NHS Foundation Trust||NHS South Sefton Clinical Commissioning Group|
|Mental Health||Countess of Chester Hospital NHS Foundation Trust||North West Boroughs Healthcare NHS Foundation Trust|
|Metabolic and Endocrine||Cumbria County Council||Royal Liverpool and Broadgreen University Hospitals NHS Trust|
|Neurological||Innovation Agency (AHSN North West)||Sefton Council|
|Public Health Neighbourhood Resilience Programme||Knowsley Metropolitan Borough Council||University of Central Lancashire|
|Renal and Urogenital||Lancashire County Council||University Hospitals of Morecambe Bay NHS Foundation Trust|
|Respiratory||Lancashire Care NHS Foundation Trust||University of Liverpool|
|Stroke||Lancashire Teaching Hospitals NHS Foundation Trust||Walton Centre NHS Foundation Trust|
|Domestic Violence and Abuse||Lancaster University||Warrington and Halton Hospitals NHS Foundation Trust|
|Dementia||Lancaster City Council||Wirral University Teaching Hospital NHS Foundation Trust|
|Palliative and End of Life care||National CLAHRCs (see All CLAHRC National Projects Tab)|
|Long-Term Conditions||CLAHRC North Thames||CLAHRC East Midlands|
|Emergency Care||CLAHRC Greater Manchester||CLAHRC Northwest London|
|CLAHRC Oxford||CLAHRC South London|
|CLAHRC Southwest Peninsula||CLAHRC Wessex|
|CLAHRC West||CLAHRC Yorkshire and Humber|
|CLAHRC East of England|
|The list of research projects listed here are in progress or nearing completion across CLAHRC NWC and from our CLAHRC colleagues across the UK.|
|Our Partners are encouraged to contact the Principal Investigators to find out more about an individual project for the purpose of enhancing their clinical practice, reducing health inequalities or improving public health work. We want to share potential results and implement findings in partnership, which are beneficial to our Partner organisation. We actively encourage Partners to share this list internally with their key departments to ensure front-line staff have access to this information.|
|CLAHRC North West Coast Projects|
|Link for Full project details||Title||Evidence of Effectiveness||Implementation Status|
|CLAHRC NWC 001||Developing personalised renal function monitoring||Developing personalised kidney function monitoring guidelines based on the characteristics of individual patients (for example: severity of heart failure, drugs being taken and other diseases that they might have). The availability of such monitoring protocols could change clinical care pathways, and potentially reduce hospital admissions, reduce cost and improve patient quality of life.||Near completion|
|CLAHRC NWC 002||Accelerating Delivery Of Psychological Therapies after Stroke (ADOPTS)||Stroke can have huge emotional impacts on stroke survivors and their carers. However, psychological services and support for these difficulties have been shown to be insufficient. Evidence and guidance to enable service providers to provide appropriate supports is lacking. We have developed an evidence-based pathway to enhance access to psychological support. Staff have received training to identify psychological distress and increase their confidence, to deliver low level psychological support. Depression affects about one in three stroke survivors at any one time, and up to half of all stroke survivors at some time and many more have emotional distress which negatively affects their life. Depression can reduce people’s ability to take part in rehabilitation, resulting in longer hospital stay and poorer recovery, and prevent them from taking part in social and leisure activities on returning home.|
Patients and carers will benefit from receiving stroke care that is based on the best available evidence. Sustained reduction of depressive symptoms has immediate benefits, because depressive symptoms are unpleasant by their very nature.
The implementation of the pathway and training will ultimately lead to improved psychological care for stroke survivors, providing them with the ability to cope with the impact of stroke, and to maintain or regain psychological wellbeing, thus improving mood, increasing independence, reducing institutionalisation and mortality.
The patient pathway was successfully implemented in four sites across the North West. The main study and process evaluation is ongoing. Staff liked the practical tips and suggestions of what to say and what not to say. They reported not being so worried about trying to address some of the issues around psychological distress and IAPT staff felt more able to adapt therapy materials to assist in communication with stroke survivors
|Further work would be required to individualise the pathway at each site utilising lessons learnt from the roll out across the four sites in ADOPTS.|
|CLAHRC NWC 003||Improving access and coordination of care for adults presenting to emergency care with seizures: Care Pathway for Seizures (CAPS)||The aim of the project is to find out if actively helping patients who have attended Emergency Departments (EDs) following a seizure to attend an early (i.e. within 2 weeks) appointment will make the changes that reduce readmissions, reduce re-attendances and improve quality of life.
Assess the impact and outcomes of a new care pathway for people presenting to ED with seizures. Implement the care pathway in 3 hospitals in Merseyside and Cheshire that access neurology services from The Walton Centre. Compare outcomes over 12 months in these three hospitals with other hospitals in Merseyside and Cheshire and the NW Coast. Assess patient outcomes using patient reported outcome measures. Assess service use and performance using routinely collected data. Estimate the cost effectiveness of the new pathway.
|CLAHRC NWC 004||Transitional Care for Young Adults with Long Term Conditions||The aim of the project is to develop and implement an evidence-based intervention which improves the quality of transitional care, associated health outcomes, and reduces health inequalities for young people with complex needs across the north west coast footprint.||Ongoing|
|CLAHRC NWC 005||Improving Perinatal Access to Support and Resources (PEARS).||The 3 elements are grounded in evidence of effectiveness. There is good evidence that enhanced peer support perinatally is beneficial to mental health and wellbeing (2,3)
Use of community maps of available resources have shown improved social capital and the benefits of community engagement (4)
There is strong evidence that IF-Then planning helps people to engage in active health behaviours. It is based on the evidence that the best predictor of an action is whether a person has an intention to do something. If they do have this intention then usually only on 1 in 5 (20%) occasions does this translate to an action. This is the intention-behaviour gap. If people are helped to put in place an IF -Then plan (this is the what they will do it and how and when they will do this ) then an intention translates to action much more effectively at 50-60% of the time (5). This bridges the intention-behaviour gap
The primary outcome for the feasibility study and external pilot was use of community resources in pregnancy and to 6 months postnatally. Although not powered to demonstrate statistical difference there were indications women who had been randomised to receive the intervention had more contacts with community resources in pregnancy and postnatally when compared with a control group who just received a leaflet about what was available.
We have developed and have available the following resources:
1. a full detailed step by step pack to provide the 30 hour peer supporter training for providing the PEARS intervention. This incorporates evaluation of trainee performance to ensure training to performance criterion. This evaluation of this training by the peer supporter trainees was very positive.
2. A fidelity checklist to ensure adherence and prevent slippage of process for the intervention.
3. A guide for supervisors to providing group supervision for peer facilitators to support their continued engagement and fidelity of implementation
4. A detailed step by step guide for how to develop and routinely update a local community map.
5. A process guide for midwives to facilitate recruitment.
|CLAHRC NWC 007||TechCare: Mobile-AssessmenT and ThErapy for PsyCHosis: An intervention for Clients within the EArly InteRvention SErvice.||Technological advances in healthcare have shown promise when delivering interventions for mental health problems such as psychosis. The aim of this project is to develop a mobile phone intervention for people with psychosis and to conduct a feasibility study of the TechCare App.||Ongoing|
|CLAHRC NWC 008||Exploring factors affecting the diets and infant feeding practices of pregnant and post-partum women in NW England (PhD)|
|CLAHRC NWC 009||Interventions for adults with intellectual disabilities who are obese||Obesity is a major risk factor for these conditions. The research highlights that obesity is more common in adults with intellectual disabilities in England than in the general adult population of England and yet there are gaps in evidence-based weight management interventions for this population group.||The findings from this research are expected to inform policy, guidance and practice relating to the tailoring of evidence-based weight management interventions for adults with intellectual disabilities who are obese or overweight.
Please use the contact details below to discuss how these findings can be of use in your service provision. Further co-produced and collaborative action is required to help address the inequities and inequalities experienced by adults with intellectual disabilities who want to manage their weight.
|CLAHRC NWC 011||Building a research resource to support the development and evaluation of innovative approaches to reduce health inequalities in the NIHR CLAHRC NWC Neighbourhoods for Learning|
|CLAHRC NWC 015||Systematic review of barriers and enablers to South Asian women's attendance for asymtomatic screening of breast and cervical cancers||The purpose of this review was to collate information on all of the studies that have been conducted to date on South Asian women and asymptomatic screening for female cancers. This enabled researchers to synthesize the literature on cultural and individual beliefs and attitudes and their effects on individual women’s screening attendance and willingness to consult health professionals for cancer symptoms.||High quality research on screening attendance is required, where attendance is predicted from cultural understandings, beliefs, norms and practices; thus informing policy on targeting relevant public health messages to the South Asian communities about screening for cancer, and be useful for healthcare commissioners to decide how best to invest resources in areas with large ethnic groups. Please get in touch if you are interested in learning more about these results to help deliver cancer services to this population segment.|
|CLAHRC NWC 016||Considering the impact of health inequalities in evidence synthesis|
|CLAHRC NWC 017||The health inequalities associated with post-stroke visual impairment||The aim of this project is to establish the type of visual impairments found in stroke survivors, the extent and timeline of recovery these impairments, and to compare the visual function measures longitudinally for stroke survivors with visual impairment.|
|CLAHRC NWC 019||Does day care promote independence and wellbeing for older people with moderate care needs and their carers?||The aim of the project is to explore models of day care for older people and examine its impact on their wellbeing, independence and social isolation and that of their carers, in rural and urban areas. To determine if the professional models of day care provide better outcomes for older people with multimorbidities than voluntary models.||Ongoing|
|CLAHRC NWC 021||Implementation of genotype-guided dosing of warfarin for atrial fibrillation to improve anticoagulation control||Carrying out a genetic test before prescribing Warfarin can help healthcare professionals to know what the correct warfarin dose is more quickly and stabilise patients on Warfarin.
We have implemented this test, in several North West hospitals, as part of the routine clinic visit prior to giving patients with AF, Warfarin to improve the time it takes to find the most suitable Warfarin dose. This will reduce the amount of times that patients need to attend hospital, reduce the amount of times that patients experience bleeding side effects, improve the patient experience and help patients to manage their medication better. We want to examine whether the test can be cost effective and find out what staff think about and how it can become part of the routine in clinics.
For trusts keen to implement this research, on completion, please use contact details below.
|CLAHRC NWC 022||Neighbourhoods for Learning (NsfL) Integrated Longitudinal Research Resource|
|CLAHRC NWC 023||Pancreatic enzyme replacement therapy for chronic pancreatitis. Systematic review and meta-analysis|
|CLAHRC NWC 024||Perinatal Mental Illness and Health Inequality|
|CLAHRC NWC 025||Improving Radiotherapy Outcomes for Head and Neck Cancer Patients with Addictions|
|CLAHRC NWC 027||Reducing Health Inequalities: Narrowing the gap in respiratory disease|
|CLAHRC NWC 029||The Physical health needs of mental health service users: Exploring the views of people taking antipsychotic medication.|
|CLAHRC NWC 030||Association of early years social deprivation on dental health in children; a Millennium Cohort study|
|CLAHRC NWC 031||Weight [Re]Gain Post Bariatric Surgery|
|CLAHRC NWC 032||Implementing a systemic change in Knowsley to improve mental health knowledge and build mental toughness. |
|CLAHRC NWC 033||Public Health Neighbourhood Resilience Programme||Ongoing|
|CLAHRC NWC 034||PROcalcitonin Monitoring in paediatric Outpatient antimicrobial Treatment||The aims of the project are:
a) To evaluate whether procalcitonin monitoring helps individually optimise antimicrobial duration in pOPAT and
b) To assess whether procalcitonin monitoring is offered to, and accepted by, pOPAT patients equitably with regards to social deprivation
|CLAHRC NWC 035||Strategy to Improve Detection and Reporting of Adverse Drug Reactions||In this programme of work we will be looking at ways to improve the detection and reporting of ADRs. To do this we will undertake several pieces of work that will include both healthcare professionals and patients.
This includes: 1) Implementing the Liverpool ADR Causality Assessment Tool into local practice for ‘real world’ assessment. This tool is designed to be used by healthcare professionals to help them decide whether a reaction has been caused by a specific drug. It is known that assessing ADR likelihood without guidance can lead to disagreements between healthcare professionals. 2) Creating a collection of blood, urine and data from patients, known as a biobank. This biobank will allow us and other researchers to investigate why certain people might be at greater risk than others of having an ADR. 3) Evaluating the implementation of an educational course aimed at junior doctors. Part of this course will require the junior doctors to identify and evaluate the causes of suspected ADRs. Following completion of this course a process will be undertaken to assess whether ADRs are addressed well in the course content. 4) Evaluating the implementation of an online resource, known as a portal, for cancer patients to report ADRs. Expectations that anti-cancer drugs will have unpleasant side effects in order to be effective may lead to ADRs being under-reported. It is hoped that by undertaking this fourth piece of work that the portal can be improved and barriers to using it can be overcome so that patients will be able to report any reactions more easily.
|CLAHRC NWC 038||The Role of Reading in Adult and Child Mental Health and Wellbeing: A Systematic Review||The aim of the project is to systematically review the evidence assessing the impact on the mental health of adults and children of reading programmes or interventions designed to promote reading.||Near completion|
|CLAHRC NWC 039||Patient-reported experience of a seizure care pathway: development and validation of a new measure|
|CLAHRC NWC 043||Languages and mass media approaches to health|
|CLAHRC NWC 044||Horticulture, hyper masculinity and mental wellbeing: the connections in a male prison context.||The aim of the project is to explore the role of horticultural projects in north west prisons. Greener of the Outside: For Prisons (GOOP) is a horticultural project that runs in almost all north west based prisons aiming to improve mental health, develop social and communication skills between inmates and instil a rehabilitative culture for prisoners who are soon to be released to the community by providing horticultural qualifications as well as basic maths and English courses.
Specifically, this project will aim to investigate the role that GOOP has upon hypermasculine environments and how the role of horticulture can counteract those masculine barriers of opening up, trusting and mutually sharing feelings in order to improve mental wellbeing.
|CLAHRC NWC 045||Realist Evaluation and Synthesis to Assess Health Inequalities. Revised working title: Working upstream: examining a central idea in addressing health inequalities||To examine interdisciplinary understandings of what it means to work in an upstream capacity to reduce health inequalities.||Ongoing|
|CLAHRC NWC 046||Influence of socioeconomic status in the communication of head and neck cancer patients with healthcare professionals.||The aim of the project is to investigate how socioeconomic status (SES) affects communication during clinical encounters in head and neck oncology review consultations, and reduce the amount of times that patients need to attend hospital, reduce the amount of times that patients experience bleeding side effects, improve the patient experience and help patients to manage their medication better. We wanted to examine whether the test can be cost effective and find out what staff think about and how it can become part of the routine in clinics.||Ready for implementation to front line service providers providing cancer treatment.|
|CLAHRC NWC 048||The influence of neighbourhood environment upon propensity to engage in physically active occupations||Physical inactivity is a major contributor to chronic physical health conditions and can exacerbate mental health problems. Levels of physical activity are significantly lower in the north of England to the south and the north-south divide is further evidenced by disparities in health status and household income. Why is this?
1) Gain insight into the factors influencing physical activity as part of daily routine.
2) What type of physical activity is taking place?
3) Where does this occur?
4) How can these data be interpreted in line with recognised health inequalities?
|Results by end of 2018.|
|CLAHRC NWC 049||Impact of personalised medicine on health disparities|
|CLAHRC NWC 050||Pathways to Inequalities in Child Mental Health||Reducing inequalities in mental health outcomes is a public health priority in the UK, and there is increasing recognition that the early years of a child’s life are critical periods during which inequalities can develop. With this in mind, this project aims to explore the effect of socioeconomic status on early years’ trajectories in child mental health and development outcomes, in the MRC funded Wirral Child Health and Development Study (WCHADS) and Millennium Cohort Study (MCS).||Ongoing|
|CLAHRC NWC 051||Qualitative research into who does not complete TB treatment and why? What can be done to help support people through their TB treatment||The aim of the project is to understand if there is a particular group / groups of patients who do not complete their TB treatment i.e. lost to follow up or failed to complete and why they did not complete treatment.
To understand which group of people from the highest complexity graded patient are more likely to fail treatment or be lost to follow up To establish why these people do not adhere / collaborate with their treatment plan Understand if there is a gap in services provided or available for the TB patient across the North West.
|CLAHRC NWC 52||The role of young people in public services supporting youth health and wider wellbeing in|
North West city neighbourhoods: an analysis and interpretation using systems concepts
|CLAHRC NWC 053||Investigating the evidence of, and causes behind, greater socio-economic related health inequalities on the UK coast|
|CLAHRC NWC 054||A cross-sectional study of the role of rumination in the relationship of the socioeconomic environment and mental health.||The aim of the project is to investigate the role of rumination as a psychosocial coping mechanism underpinning long term mental health issues and levels of deprivation. This will be done trans diagnostically, but there will also be an exploratory comparison between samples with bipolar disorder, depression, schizophrenia and healthy population.||Ongoing|
|CLAHRC NWC 055||Reducing traumatic birth experiences for disadvantaged women through improved awareness, attitudes, behaviours and practices among maternity professionals: A study to assess the feasibility and acceptability of developing and using a tailored educational programme.||This project aims is to reduce traumatic birth experiences for disadvantaged/vulnerable women by improving attitudes, behaviours and practices amongst maternity professionals.||Ongoing|
Of value to any training teams of trusts providing midwifery services.
|CLAHRC NWC 058||Mindful Contact with Nature: Evaluating the effects of mindfulness and connection with nature on chronic stress and well-being in deprived areas||Research suggests that eco-therapeutic approaches could be significantly advantageous in reducing the effects of urbanisation, chronic stress and health inequalities. Intuitively, the theoretical underpinning of mindfulness lends itself as a mechanism through which negative impact of urbanisation can be facilitated. The aim of this project is to generate an evidence base for the combined impact of mindfulness and nature, concentrating on reducing health inequalities for those with chronic stress living in areas of socio-economic deprivation.||Ongoing|
|CLAHRC NWC 059||To investigate the effectiveness of Crewe Recovery College on improving mental Health services in a deprived area|
|CLAHRC NWC 060||Exploring the impact of worklessness and employment on mental health and wellbeing outcomes of young people/young adults aged 18-24 years.|
|CLAHRC NWC 063||A series of systematic reviews related to asthma treatment in children, examining the environmental, socio-economic and pharmacogenomics associations between both efficacy and adverse effects of medications used in moderate to severe asthma|
|CLAHRC NWC 064||The treatment and implementation of care planning for frail and elderly patients across multi-disciplinary teams|
|CLAHRC NWC 67||Increasing the uptake of TB services and treatment within deprived groups|
|CLAHRC NWC 071||Improving Mental Health: Household Health Survey and Integrated Longitudinal Research Resource Analysis and Dissemination of Findings|
|CLAHRC NWC 073||The role of young people in public services supporting youth health and wider wellbeing in North West city neighbourhoods: an analysis and interpretation using systems concepts.||This research aims to develop understanding of how youth-stakeholder interactions shape local approaches to youth health and wellbeing, and their role in shaping the relevance of public health policy and practice to young people’s lives||Ongoing|
|CLAHRC NWC 074||Facilitate public led research into inequalities in mental health care||The active involvement of service users and members of the public in health research is now a central funding criterion for the NIHR. This project seeks to take public involvement further by enabling the development of a high quality public led mental health related research proposal suitable for funding through the NIHR.||Ongoing|
|CLAHRC NWC 077||Evaluation of the implementation of the GP Specification (a quality contract) in Liverpool||The aim of this evaluation is to determine the impact that the implementation of the GP Specification (a quality contract) has made upon healthcare activity, quality of general practice and patient experience over a 5-year period. This will be assessed against 4 key areas, which are:
1. Changes in the management of Long Term Conditions
2. Changes in the use of secondary care resources
3. Changes in health inequalities
4. Changes in the behaviour/system changes in General Practice
For shared learning purposes CCGs are encouraged to get in touch with the team.
|CLAHRC NWC 078||The Effectiveness of Multidisciplinary teams In increasing integration of care to reduce hospital activity, improve health and wellbeing and decrease health inequalities||A co-produced systematic review of the evidence to inform the key question raised by the CLAHRC NWC Partners in relation to the Partner Priority Programme (PPP); ‘Which out of hospital treatments and care are most (cost) effective in reducing health inequalities, improving wellbeing and reducing emergency admissions||Ongoing|
|CLAHRC NWC 079||Evaluation Plan for Clinical Decision-Making in the Use of Inpatient Mental Health Beds: improving practice and patient experience||The purpose of this study is to understand the decision making made by health professionals to admit service users onto inpatient acute psychiatric wards. It is hoped by understanding this decision making recommendations can be made to improve practice and patient experience.||Ongoing|
|CLAHRC NWC 081||Preventing emergency admissions of cancer patients in Liverpool – mixed method study|
|CLAHRC NWC 082||Evaluation of the recently-developed, integrated, Consultant led community-based diabetes service||The evaluation of Liverpool Diabetes Partnership is to assess the impact on the Diabetes population of Liverpool Sense check with the population on the service and the providers and identify areas for improvement. To ensure that the resources are directed at those who need it the most therefore impacting on health inequality across Liverpool.||Ongoing|
|CLAHRC NWC 084||The Knowsley Community Respiratory Service Evaluation Project (COPD)||The aim of the project is to determine whether the COPD element of the KCRS initiative has delivered on its intended objectives. The objectives of the project will be to: 1. Conduct an evaluation of the COPD element of the Knowsley community Respiratory service initiative in order to assess whether it has led to an improvement in access to specialist COPD services for patients and carers across all socio-economic groups especially the hard to reach communities and stakeholder have a positive opinions on the service in terms of quality and integration as a single health and social care pathway 2. To assess whether the initiative has led to a reduction in rates of emergency hospital admissions and readmissions, North West Ambulance Service Trust call-outs rates, secondary care activities, hospital length of stay, and premature deaths. 3. To assess whether initiative has reduced mortality and premature mortality rates over time.||Ongoing|
|CLAHRC NWC 086||Evaluating the impact of Community Care Teams||This evaluation will aim to provide evidence of the impact of multi-disciplinary integrated Community Care Teams (CCTs) have on preventing hospital admissions, readmissions and delayed transfers of care.
These teams will work within 12 neighbourhood teams that cover the whole of Liverpool. We will measure the impact of these teams on City wide outcomes as well as exploring these outcomes at neighbourhood level to identify any impact these teams have on health inequalities.
- Introduction of MDT working for Community Matrons, District Nurses, Allied Health Professionals, Medicines Management, Social Workers and Mental Health professionals.
- Introduction of a local Generic Assessment and Evaluation Tool (GATE) for team
- Training of local social care staff in the use and administration of electronic clinical system
- Reporting from social care staff on clinical systems
|CLAHRC NWC 087||The Knowsley Community Cardiovascular Disease Evaluation Project||Whether the Knowsley community CVD service initiative has delivered on its intended objectives. The objectives of the project will were to: Understand if the implementation of the Knowsley CVD Service has improved access into specialist CVD service; Analyse if access and uptake into Knowsley CVD service and recommended treatments is equitable across Knowsley; To discover if there is an impact on CVD mortality within Knowsley since the service was implemented.||Ongoing|
Of interest to any service provider providing clinical community services who wish to evaluate its impact.
|CLAHRC NWC 088||Community integrated mental health and physical health service|
|CLAHRC NWC 089||Community Diabetes Service|
|CLAHRC NWC 091||Evaluation of the Bowel Cancer Screening Intervention in deprived areas of Liverpool|
|CLAHRC NWC 097||Tackling health(care) inequalities for a healthier Liverpool: understanding food and medicines poverty in cardiovascular disease management|
|CLAHRC NWC 106||To understand the impact of the YIAC (Youth Information Advice and Counselling) model on access, engagement and mental health for young people aged 14-25 years|
|CLAHRC NWC 108||Well-being after stroke: How can General Practice help?|
|CLAHRC NWC 111||Overarching evaluation framework for public health mental health and well being interventions (Public Health England with various Local Authorities |
|CLAHRC NWC 113||Evaluation of the STEP (Succeed, Thrive, Empower Pennine) Service||Pennine Lancashire is the name given to the geographical area within which East Lancashire CCG and Blackburn with Darwen CCG operate as clinical commissioners.
Historically, the two CCGs have commissioned health services separately, and in their own ways, but more recently, they are starting to develop a more integrated, partnership approach as part of the Sustainability and Transformation Plan process. The Pennine. This evaluation will focus on the different approaches to integrated care in each of the neighbourhoods in Pennine Lancashire. It will enable an analysis of the best elements of each, and an opportunity to identify learning from each of them. This will allow a joint, integrated and holistic service model to be developed.
The evaluation will assess the impact of the service on the quality of life for patients, patient satisfaction, and impact on other services including reduction in unnecessary use of services such as emergency admissions and A&E attendances.
Further quantitative analysis of the outcome data at neighbourhood level is being completed with further contrast to the population demographics of each neighbourhood to ensure equity of outcomes.
Of interest to Clinical Commissioning Groups implementing Sustainability and Transformation plans.
|CLAHRC NWC 116||Wigan Later Life and Memory Service (LLAMS) – improving young onset dementia (YOD) services|
|CLAHRC NWC 145||To understand the impact of the YIAC (Youth Information Advice and Counselling) model on access, engagement and mental health for young people aged 14-25 years|
|CLAHRC NWC 147||Evaluation of Telehealth for COPD: Re-design of respiratory services in Liverpool|
|CLAHRC NWC 155||The NIHR CLAHRC NWC Household Health Survey: Assessing health inequalities across the North West Coast of England|
|CLAHRC NWC 161||Environmental and genomic factors influencing child respiratory health is my title currently|
|CLAHRC NWC 162||Exploring links between primary care use, mental health and well-being, A&E attendance and health inequalities (HHS)|
|The list of research projects listed here are in progress or nearing completion across CLAHRC NWC and from our CLAHRC colleagues across the UK.|
|Our Partners are encouraged to contact the Principal Investigators to find out more about an individual project for the purpose of enhancing their clinical practice, reducing health inequalities or improving public health work. We want to share potential results and implement findings in partnership, which are beneficial to our Partner organisation. We actively encourage Partners to share this list internally with their key departments to ensure front-line staff have access to this information.|
|National CLAHRC Projects|
|Link for Full project details||Title||Evidence of Effectiveness||Implementation Status|
|CLAHRC North Thames|
|National CLAHRC 001||Improving uptake of the NHS Bowel Cancer Screening Programme (BCSP) using GP practice endorsement of the bowel cancer screening invitation.||The addition of a simple statement of GP endorsement to the standard NHS Bowel cancer Screening Programme invitation letter increased the odds of uptake of gFOBT by 7% (adjusted OR:1.07, 95% CI 1.04-1.10, P<0.0001). We calculated that if GPE were implemented nationally, 39,766 extra people would be screened per annum. This could result in up to 165 more people with high or intermediate risk colorectal adenomas and 61 cancers detected per year.This intervention represents an almost cost-free approach to enhancing screening uptake, with no effort required from GPs other than their agreement to have the practice name on the letters.||Yes. There are five NHS BCSP Hubs covering England. All the Hubs participated in the Trials and have the enhanced invitation letter is on their system. One of these (London) has already implemented the intervention as part of its routine practice. Hubs will need to ensure that GP practice addresses are up to date, but this is done as part of their routine work. The Hubs all work closely together so could easily confirm (with London) the additional work required to implement the intervention.|
|National CLAHRC 002||Co-located welfare advice in general practice||Our controlled prospective quasi-experimental study* demonstrated, relative to controls:|
Significantly greater reduction in common mental disorder over time among those receiving advice for females and Black/Black British participants (63% and 91% bigger reduction respectively).
Those with a positive outcome of advice (e.g., if advice led to improvements in income or housing circumstances) experienced significantly improved mental well-being scores.
For the advice group overall there was a significantly greater reduction in financial strain (58% bigger reduction overall).
Advice recipients gained on average £15 per capita, for every £1 spent by commissioners - averaging £2689 per person.
Nearly half of advice recipients would not have sought advice, or would have turned to their GP had the service not been there.
Our realist qualitative study** revealed that co-located services may also reduce pressure on GPs and other practice staff experiencing heightened demand for ‘non-clinical’ support, and increase their capacity to support patients whose health is affecting, or being affected by social problems by:
Offering a signposting option for staff in contact with patients with ‘non-clinical’ social needs.
Helping to address underlying patient social issues.
Providing an alternative option for patients seeking help for such issues. *Woodhead C, Khondoker M, Lomas R, Raine R. Impact of co-located welfare advice in general practice: prospective quasi-experimental controlled study 2017; bjp.bp.117.202713. DOI: 10.1192/bjp.bp.117.202713
Parkinson A, Buttrick J. The Role of Advice Services in Health Outcomes Evidence Review and Mapping Study. Consilium Research and Consultancy, 2015.
|Yes – co-located welfare advice services have been operating in several areas across the UK but coverage is often patchy and transient with short term funding and frequent closures of many services. This is against a backdrop of reduced funding for socio-legal services in general (33% decline in coverage between 2005 and 2008) and until now much of the available evaluation evidence has been methodologically limited.|
Locations currently involved include:
Liverpool CCGs: recently rolled out their Advice on Prescription service across most practices, with a five year funding periodDerbyshire CCGs : services operate across nearly all practices, jointly funded with public health (LA) which may be more sustainable.
Haringey : services have been retained in only a small number of practices (funded by clinical commissioners but the service is constantly at risk [due to financial pressures] because it is not a directly clinical service
Elsewhere, (e.g. Lambeth) services have ceased.
We would argue that our published evidence, together with the contextual information described in point 5 (below) can be (and has been) used to provide the case for continued funding, expansion or establishment of the service (as appropriate).
|National CLAHRC 003||Implementing HIV screening in general practice to cost-effectively deliver increased and earlier detection of HIV||Our RHIVA programme:|
HIV screening at general practice registration is acceptable and feasible [STI 2009].
In our RHIVA2 cluster randomised controlled trial of 40 general practices in Hackney, a high HIV prevalence borough, screening led to a four fold increase in detection of HIV infection [Lancet HIV 2015].
HIV infections were detected earlier through screening, as judged by CD4 count at diagnosis.
Our dynamic transmission health economic model showed that screening in the medium term was cost-effective by NICE criteria [Lancet HIV 2017].
Screening saves £372,207 per death averted, and £628,874 per HIV transmission averted.
However, low uptake of HIV testing (10-40%) is a widespread problem across HIV testing strategies, including the national HIV testing pilots, and studies based on HIV-indicator condition testing or risk.
Nineteen of 325 local authorities in England are defined by NICE as very high HIV prevalence (5+/1000 ); 74 are defined as high prevalence (2+/1000). To deliver the most health gain we propose initially to support implementation in the former. http://www.thelancet.com/journals/lanhiv/article/PIIS2352-3018(15)00059-4/fulltext
|Yes – with City & Hackney CCG commissioning, we successfully implemented the RHIVA2 intervention as a clinical service as part of the general practice sexual health local enhanced service. Our implementation programme of practice training visits, insertion of screening-prompt templates, data feedback, and ongoing quality assurance was highly acceptable to practices [Trials 2015]. Our analysis of effectiveness and cost-effectiveness demonstrates sustained and increased HIV testing and new diagnosis during the three year post trial follow up period. Additional data on implementation will come from our comparison of Hackney data with the successful sexual health network improved service in neighbouring Tower Hamlets CCG. We have an unparalleled track record of successful implementation and quality improvement support - we delivered similar GP screening programmes in tuberculosis [Lancet 2006], the precursor to the national latent TB screening programme, and hepatitis [NIHR PGfAR in progress, [Foster RP-PG-1209-10038]. We could extend implementation to high prevalence boroughs in other CLAHRCs and AHSNs. Furthermore, our leading edge data science quality improvement support has enabled east London practices to deliver 2016/17 QOF rankings of 1st, 2nd or 3rd out of 207 English CCGs in 15 of the 60 clinical indicators https://qof.digital.nhs.uk . Our programme would help address the wide variations in sexual health care and support the UK in achieving the World Health Organisation’s FastTrack strategy to eliminate HIV transmission within the next five to seven years.|
|National CLAHRC 004||Improving the healthcare response to domestic violence & abuse (DVA)||Building on a large pragmatic multi-site cluster randomised controlled trial (Lancet 2011), the four-year CLAHRC North Thames programme of IRIS-based research, working collaboratively with CLAHRC West and the University of Bristol, evaluated the sustained effectiveness of IRIS implemented in routine care in multiple northeast London CCGs, using an interrupted time series design. We found that IRIS increased referrals received by DVA service providers from GPs by an incidence rate ratio of 30 (95% C.I. 20 to 45). 109 GP practices made 1,058 referrals. An alternative DVA initiative, in a comparable neighbouring CCG did not increase referrals received: IRR 0.9 (95% C.I. 0.13 to 6.84). Our programme included a national cost-effectiveness analysis of IRIS, based on NE London and Southwest data, estimating a societal cost saving of £14/woman registered in an IRIS practice and an 0.001 QALY gain/woman. For society, IRIS is cost-effective and saves money. For the NHS, IRIS is cost-effective and good value. A GP described IRIS as “…undoubtedly the most successful project of its kind…” Further collaborative research between CLAHRC North Thames and CLAHRC West has demonstrated the feasibility of IRIS modified for sexual health services - IRIS ADViSE (STI 2017); and work is underway exploring its feasibility with community pharmacists. This much needed focus on the management of DVA in clinical practice is long overdue, given its long term damage to the health and wellbeing of women (and their children), exceeding that of hypertension, obesity, high cholesterol and smoking in women of reproductive age.(Vos et al, 2006 )||Yes, IRIS is ready for implementation without further specific work. Our central partnership is with IRISi (see below) - a newly founded national social enterprise responsible for the commissioning and on-going development of IRIS, ensuring that IRIS stays evidence-based, responding to the emerging evidence, including the IRIS/CLAHRC findings.|
|CLAHRC East Midlands|
|National CLAHRC 005||Group psychoeducation for bipolar disorder||Group psychoeducation was found to be effect in recent meta-analysis (Bond and Anderson, 2015; Oud et al, 2016). In a large multicentre randomised controlled trial we showed that compared to unstructured group peer support, PE was more acceptable, delayed relapse into mania and improved interpersonal function in all patients with bipolar disorder, and was effective against all bipolar disorder episodes in people with 7 or fewer episodes. It was cost effective in terms of relapse prevented and reduced costs compared to standard care if 15% relapses were prevented over 2 years. Other RCTs showed clinical effectiveness and up to one third less cost over 5-6 years with guideline delivered medication compared to standard mental health care (Colom et al, 2010; Kessing et al, 2013). PE has been implemented in Nottinghamshire Healthcare Trust for 4 years with evidence of reduced major relapse and improved function, confirming the results from trials in routine practice.||Ideally video materials of the delivery of the intervention would help implementation at scale. Otherwise no further work.|
|National CLAHRC 006||A community based approach for implementation of a multi-ethnic diabetes risk score to identify those at high risk of type 2 diabetes||Uptake of the risk score and subsequent lifestyle advice is at its highest when delivered in community settings (faith centres, community settings & community pharmacies). Use of the risk score with Black and Minority Ethnic groups in faith centre settings has been proceeded by high attendance to structured education aimed at preventing diabetes. Wide scale implementation of the tool has the potential to raise awareness of type 2 diabetes risk and increase uptake to structured education such as the National Diabetes Prevention Programme, particularly in ethnically diverse communities.||We have English, Gujarati, Bengali and Gurmukhi Punjabi translated versions available online (link below). We have trained educators from the EDEN education team who can provide bespoke training to clinical and non-clinical staff and community or faith leaders to allow them to deliver the tool and subsequent lifestyle advice to their own community to increase awareness of diabetes risk.|
|National CLAHRC 007||Mental Health Capacity Act Booklet||The booklet has been accessed on line or in printed form 90,000 times. A survey conducted among 50,000 on line users of the booklet reported 95% had found the booklet useful and 80% recommended it to friends and family. Qualitative data from the first users of the booklet reported examples of use of the booklet to create advanced refusals to decline treatment and wishes and statements about personal welfare among patients with bipolar disorder (Morriss et al, 2017).||The booklet and Recovery College course are complete and tested. An optional extra is to improve the content of training for psychiatrists to improve their understanding of the MCA in existing training schemes usually run by MCA leads in existing mental health trusts.|
|CLAHRC Greater Manchester|
|National CLAHRC 008||Implementing Home Blood Pressure Monitoring in Primary Care||A recent meta-analysis found that self-monitoring of blood pressure in hypertension results in important decreases in blood pressure over and above standard care, when it is used in conjunction with tailored support (such as patient education or lifestyle counselling). Even in the absence of tailored support, it acknowledged that, while home monitoring on its own may not lower blood pressure, it may be useful for other reasons, such as engaging with patients or reducing clinician workload. Tucker KL, Sheppard JP, Stevens R, et al. Self-monitoring of blood pressure in hypertension: A systematic review and individual patient data meta-analysis. Rahimi K, ed. PLoS Medicine. 2017;14(9):e1002389. doi:10.1371/journal.pmed.1002389.||Yes|
|National CLAHRC 009||Six month post-stroke reviews||The requirement for six month post-stroke reviews is based on clinical/service user consensus. It was a specific recommendation of the 2007 National Stroke Strategy and is currently one of the NICE Quality Standards for Stroke in Adults (2016) and forms part of the CCG Outcome Indicator Set that was reported in December 2014, December 2015 and December 2016 in England.
The feasibility and acceptability of using the GM-SAT to assess the needs of stroke survivors was explored through a study conducted by NIHR CLAHRC Greater Manchester in partnership with the Stroke Association. Rothwell K, Boaden R, Bamford D, Tyrrell PJ. Feasibility of assessing the needs of stroke patients after six months using the GM-SAT. Clinical Rehabilitation. 2013;27(3):264-271. doi:10.1177/0269215512457403. The GM-SAT is now used by the Stroke Association across England and beyond, to deliver six month post-stroke reviews for stroke survivors across 42 services. The number of reviews using GM-SAT has steadily increased over the years since its initial use, with almost 17,000 reviews having been conducted by the Stroke Association to date [figures as of April 2017]. The GM-SAT itself is also referenced by the NICE Quality Standard for Stroke in Adults and the British Association of Stroke Physicians’ clinical standards for six month reviews, and a national audit of service provision found the GM-SAT to be the assessment tool most commonly used for six month post-stroke reviews nationwide. http://emahsn.org.uk/images/Section_4_-_How_we_are_making_a_difference/Stroke/Summary_Report_-_National_Audit_of_6_month_reviews_after_strokeFINAL.pdf
|National CLAHRC 010||Improving the physical health of people with severe and enduring mental illness.||Premature mortality rates have been reported for people with SMI for many years, leading to a reduced life expectancy of up to 25 years compared to the general population . This is largely due to physical inactivity, an unhealthy diet, and a high smoking prevalence, in combination with medication induced weight gain which in return can lead to metabolic disorders (e.g. type 2 diabetes),,.
Despite the fact that many of the physical health issues experienced by this group, e.g. cardiovascular diseases or diabetes, are preventable or controllable by chronic disease management, and many of the outlined lifestyle issues can be addressed by timely and patient-centred access to health promotion, people with SMI continue to experience health inequalities, particularly in relation to the provision of physical health services. In its current mental health strategy, the UK Government sets out the objective that “more people with mental health problems will have good physical health”; however, there remain several questions over the provision of good physical health care.
 Editorial., No health without mental health. The Lancet. (2011) vol.377 p.611
 McCreadie R, G., Diet, smoking and cardiovascular risk in people with schizophrenia. The British Journal of Psychiatry (2003) Vol.183 pp.534-539
 Henderson, D.C., Cagliero, E., Gray, C., et al. Clozapine, diabetes mellitus, weight gain, and lipid abnormalities: a five-year naturalistic study. American Journal of Psychiatry, (2000) Vol.157, pp.975-981.
 Brown, S., Birtwistle, J., Roe, L., et al. The unhealthy lifestyle of people with schizophrenia. Psychological Medicine (1999) Vol.29, pp.697-701.
 Department of Health., No Health without mental health – delivering better mental health outcomes for people of all ages. Crown (2011)
|CLAHRC Northwest London|
|National CLAHRC 011||Atrial Fibrillation Screening with Alivecor technology.||From 1 October 2015 to 9 May 2017, 8270 patients at risk of AF have had a new ECG test (689 patients newly diagnosed with AF). A review of AF at risk individuals in August 2016 showed 5.09% individuals had an ECG test done within the past 12 months, increasing to 12.52% in May 2017. Communities identified by GIS mapping as having a high prevalence of undiagnosed AF were targeted through 14 community events. 619 people were screened and 5 were identified as potentially having AF and referred to their GP for further investigation. From April 2015 and March 2017, the additional number of newly diagnosed AF patients was around 209 per year. Based on a 5% risk of stroke in patients with AF without anticoagulation, 10.5 of these patients would be expected to have a stroke within each year. Given the estimated 64% reduction in the risk of stroke for AF patients on anticoagulation, it is likely that if all these additional diagnoses of AF were appropriately anticoagulated, approximately 7 additional strokes would be prevented each year. Projected cost savings to the NHS acute hospital alone equates to a yearly saving of £81,781. Improvements have been made to the medication review care pathway for people identified with AF to ensure that evidence-based decisions are made for appropriate use of anticoagulants. 347 AF patient records have been reviewed leading to 33 patients receiving appropriate anticoagulation who were not on the correct medication previously||NIHR CLAHRC Northwest London (NWL) will collaborate with Imperial College Health (ICHP) (Northwest London’s AHSN) and STP to support the roll out of the AF project across Northwest London. The partnership will utilise:
ICHP’s free supply of Kardia devices to support local uptake
CLAHRC NWL’s systematic approach to quality improvement, to support other areas to successfully implement the AF project
the strategic position of the STP to support the roll out of the AF project
1. Wolf PA, Abbott RD, Kannel WB. Atrial fibrillation as an independent risk factor for stroke: the Framingham Study. Stroke 1991;22:983–8
|National CLAHRC 012||Early Intervention in Psychosis services.||We found that persons treated by the EIP team were twice as likely to be employed or in education as those treated by community mental health teams. They were also less likely to be homeless, and more likely to report improved well-being.
The mean annual cost saving associated with being treated by EIP was £4031. The saving to the NHS if all people with a first-episode of psychosis in England were treated by EIP teams was estimated at £33.5 million annually, whilst the savings in societal costs were estimated at £63.3 million annually.
|National CLAHRC 013||Cost effective, augmented self-management for low back pain in primary care.||The additional quality-adjusted life-year (QALY) gained from cognitive behavioural intervention was 0.099; the incremental cost per QALY was 1786 pound sterling, and the probability of cost-effectiveness was greater than 90% at a threshold of 3000 pound sterling per QALY. The intervention produced sustained benefit in low back pain related disability and a range of other outcomes. The level of effectiveness was compatible with other commonly used treatments for LBP but much cheaper to deliver and sustained for a longer period. All of these effects and our experiences with implementation are published in the peer reviewed literature. RAND undertook an independent evaluation of the intervention and concluded that it could result in very substantial cost savings to the NHS. CLARHC selected this intervention as one of its ten at ten projects. Richmond H, Hall AM, Hansen Z, Williamson E, Davies D, Lamb SE Exploring physiotherapists' experiences of implementing a cognitive behavioural approach for managing low back pain and identifying barriers to long-term implementation. Physiotherapy. 2017 Jun 1. (17)30029-9 Fordham B, Ji C, Hansen Z, Lall R, Lamb SE. Explaining How Cognitive Behavioral Approaches Work for Low Back Pain: Mediation Analysis of the Back Skills Training Trial. Spine (Phila Pa 1976). 2017 Sep 1;42(17):E1031-E103 Richmond H, Hall AM, Copsey B, Hansen Z, Williamson E, Hoxey-Thomas N, Cooper Z, Lamb SE. The Effectiveness of Cognitive Behavioural Treatment for Non-Specific Low Back Pain: A Systematic Review and Meta-Analysis. PLoS One. 2015 Aug 5;10(8):e013419 Treatment compliance and effectiveness of a cognitive behavioural intervention for low back pain: a complier average causal effect approach to the BeST data set. Knox CR, Lall R, Hansen Z, Lamb SE. BMC Musculoskelet Disord. 2014 Jan 14;15:17 75 | P a g e
Group cognitive behavioural interventions for low back pain in primary care: extended follow-up of the Back Skills Training Trial (ISRCTN54717854). Lamb SE, Mistry D, Lall R, Hansen Z, Evans D, Withers EJ, Underwood MR; Back Skills Training Trial Group. Pain. 2012 Feb;153(2):494-501 A multicentred randomised controlled trial of a primary care-based cognitive behavioural programme for low back pain. The Back Skills Training (BeST) trial. Lamb SE, Lall R, Hansen Z, Castelnuovo E, Withers EJ, Nichols V, Griffiths F, Potter R, Szczepura A, Underwood M; BeST trial group. Health Technol Assess. 2010 Aug;14(41):1-253 Physiotherapy. 2010 Jun;96(2):87-94. doi: 10.1016/j.physio.2009.09.008. Epub 2010 Jan 15. A cognitive-behavioural programme for the management of low back pain in primary care: a description and justification of the intervention used in the Back Skills Training Trial (BeST; ISRCTN 54717854). Hansen Z1, Daykin A, Lamb SE Group cognitive behavioural treatment for low-back pain in primary care: a randomised controlled trial and cost-effectiveness analysis. Lamb SE, Hansen Z, Lall R, Castelnuovo E, Withers EJ, Nichols V, Potter R, Underwood MR; Back Skills Training Trial investigators. Lancet. 2010 Mar 13;375(9718):916-23.
|National CLAHRC 014||The Long Term conditions Questionnaire||It has the great strength of being developed in partnership with patients and the public who identified and co-developed the content of the questionnaire. Only with its widespread use to inform patients’ providers’ and organisations’ decisions can we truly claim that it has health gain.||It is simple to use, complete and score and therefore ready to use. Further evidence of its performance in the widest range of contexts is needed.|
|National CLAHRC 015||Dignity+||Findings from interviews, field visits, questionnaires and health information identified social and practical benefits for residents, staff and visitors along with positive changes in practice – for example, by working more closely with family members – and there were few reported negative effects.
Organisations also saw benefit from closer working and sharing knowledge.
DoH Dementia Environment Funding, DoH/IFF - Final Report: Oxfordshire ‘Dignity Plus’ Programme.
|National CLAHRC 016||Self-Management of Blood Pressure in hypertensive patients with & without co-morbidities.||Control of BP remains suboptimal in the community, despite availability of antihypertensives. The
TASMIN studies have shown the efficacy of self-management for achieving and maintaining BP control over 12 months in a general and co-morbid hypertensive population.
McManus RJ, Mant J, Bray EP, Holder R, Jones MI, Greenfield S, et al. Telemonitoring and selfmanagement in the control of hypertension (TASMINH2): a randomised controlled trial. Lancet.
McManus RJ, Mant J, Haque MS, Bray EP, Bryan S, Greenfield SM, et al. Effect of self-monitoring and
medication self-titration on systolic blood pressure in hypertensive patients at high risk of
cardiovascular disease: the TASMIN-SR randomized clinical trial. JAMA: the journal of the American
Medical Association. 2014; 312(8):799-808.
Both interventions have also been shown to be cost effective, well within the NICE threshold of
£20,000 per QALY, and in higher risk patients associated with cost savings:
Kaambwa B, Bryan S, Jowett S, Mant J, Bray EP, Hobbs FR, Holder R, Jones MI, Little P, Williams B, McManus RJ. Telemonitoring and self-management in the control of hypertension (TASMINH2): a cost-effectiveness analysis. Eur J Prev Cardiol. 2014; 12:1517-30.
Penaloza-Ramos MC, Jowett S, Mant J, Schwartz C, Bray EP, Sayeed Haque M, Richard Hobbs FD,
Little P, Bryan S, Williams B, McManus RJ. Cost-effectiveness of self-management of blood pressure in hypertensive patients over 70 years with suboptimal control and established cardiovascular disease or additional cardiovascular risk diseases (TASMIN-SR). Eur J Prev Cardiol. 2016 Jun; 23(9):902-12.
|Some additional work would be required to adapt the trial materials into daily use e.g. selfmanagement instructions. The training would need to be adapted to be delivered by practice nurses and train the trainers materials developed.|
|CLAHRC South London|
|National CLAHRC 017||Supporting people who frequently attend hospital because of alcohol-related problems||A small percentage of patients with alcohol-related problems (9%) make up a high percentage of unplanned visits to hospital and mental health care services (28%). These alcohol-related frequent attenders (AFAs) often have complex mental, physical health and social care needs, with significant cost implications for the NHS.
In a pilot trial, our researchers found that the assertive outreach services for people who drink in a hazardous way reduced alcohol consumption and people were more likely to engage in services. It found it reduced people’s use of A&E and reduced the number of times people were admitted to hospital. It increased planned care including detoxification and group therapy. In a more recent RCT, the researchers found those accessing assertive outreach had greater engagement with alcohol services at both 6 and 12 months and significantly less unplanned inpatient care and outpatient hospital visits. The research team has also completed a national survey of assertive outreach services for alcohol-related frequent attenders in England. Initial results from this survey have had a significant impact on health policy making (see CLAHRC BITE).
In Salford Royal Hospital an assertive outreach service targeting the most frequently admitted patients with alcohol related problems ‘resulted in a 59% reduction in emergency department attendances in the 3-month period post intervention. There was also a 66% reduction in average monthly hospital admissions.’ This represents a return of £1.86 for every £1.00 invested. (NICE, 2016).
In November 2016 Public Health England published a Menu of Preventative Interventions which recommended the NHS hospitals should ‘establish alcohol assertive outreach teams to reduce repeat users of hospital and other services.’
|The assertive outreach clinical team is operational in five south London trusts. The CLAHRC researchers have worked with Our Healthier South East London commissioners and the Health Innovation Network (local AHSN) to prepare a business case for expanding alcohol interventions in hospitals across south-east London. This has been included in the Sustainability and Transformation Programme for south-east London.|
|National CLAHRC 018||Helping people with psychosis to stop smoking and improve their health.||The potential gains from this work are significant:
People who have a serious mental illness often have poor physical health, and die between 15 to 20 years earlier than the general population.
An international study, led by researchers at CLAHRC South London, of more than 3.2 million people with severe mental illness showed that they have an 85% higher chance of dying from cardiovascular disease than the general population.
In south London, research has shown that people with a serious mental illness are up to three times more likely to smoke than the general population. Research published by NICE has shown that 70% of people who have a diagnosis of schizophrenia are smokers.
We are evaluating the changes that have been made at SLaM to assess their impact on health professional behaviour and patient outcomes.
For example, we are evaluating data for smoking-related outcomes for 5,864 patients. So far, we found that between 2011 and 2016 very brief advice (VBA) on stopping smoking increased from 56.1% to 83.7%.
One of the barriers to implementing smoke-free policies in mental health care settings is the perception among staff that the policies will lead to a rise in physical violence. Working with SLaM, our researchers have also assessed the impact of the SLaM smoke-free policy on incidents of physical violence. They found that physical violence actually fell by:
39% overall after the policy was introduced
47% in patients toward staff and 15% towards patients .
We also conducted a systematic review and identified 11 studies that have evaluated violence related to the implementation of smoke-free policies. The majority either found no change or a decrease in violence after such policies were introduced.
|The South London and Maudsley NHS Foundation Trust went smoke-free on 1 October 2014 and the policy has been used by other trusts going smoke free. Together with SLaM colleagues, they have hosted sessions for staff from other Trusts across England wanting to go smoke free. They have also worked with Public Health England to produce briefing papers and videos, and with the National Centre for Smoking Cessation and Training to produce good practice guidance for smoke free mental health settings. They have also helped to establish a national Mental Health and Smoking Partnership (which one member co-chairs) which aims to reduce smoking in people with mental health problems, and contributed to the delivery of webinars in this area. We have continued to collaborate with SLaM to provide an e-learning training module about smoking cessation for staff working with people who have experienced psychosis. This module is now being used by five other NHS Trusts, including Sheffield Health and Social Care Trust, part of CLAHRC Yorkshire and Humber (YH). The module is being updated to reflect current evidence. An evaluation is planned with CLAHRC YH.|
|National CLAHRC 019||Introducing standardised outcome measures for palliative and end of life care (PEoLC): Outcome Assessment and Complexity Collaborative (OACC).||Organisations collect outcomes data and return it to the central research team for analysis. This enables providers to better understand their patient population, the difference they make through their care, and to systematically improve the quality of care. One consultant using the measures said: ‘OACC has enabled us to compile clear data showing the needs, complexities and outcomes in our patient populations. This ultimately supports us in offering better person-focused holistic care. Feedback from the OACC team show our clinical teams the impact of their work. We will be able to use data from OACC to manage caseloads and allocate resources.’||The OACC team has successfully implemented the OACC suite of patient-centred outcome measures into nine PEoLC services in south London. Other services around the country are also using them (see info on training pack below).|
|CLAHRC Southwest Peninsula|
|National CLAHRC 020||Tools to support the development and implementation of Person Centred Coordinated Care (P3C).||Person-centred care (PCC) is “care where individuals’ values and preferences are elicited to guide all aspects of their health care, supporting their realistic health and life goals” (1). Person centred care alone has been shown to be effective in improving health outcomes and reducing service cost in patients with LTCs. For example, Ekman et al (2012) found P3C reduced hospital stay length by 30%, leading to significantly lower service costs in patients with chronic heart failure (2). Dudas et al (3) also found that patients had better experiences of health services due to lowered uncertainty around information and treatment. An RCT study by Arvidsdotter, Marklund and Taft (4) found anxiety was reduced by 50% when PC was implemented, compared to 10% using traditional treatment. The effectiveness of person centred care has been demonstrated in both physical and mental health conditions (5-7). In addition, a recent review of reviews focusing on interventions to improve care coordination and reduce hospitalisations concluded that outcomes improved, with a number of potentially effective interventions found (8).
The consistent reporting of the need for more person centred care in NHS (9-12) (13, 14) highlights the relevance of this project, with the recent report (15) specifically highlighting the need for a better measure both person centred and coordinated care. Using patient reported measures or organisational change tools and feeding this information back to practice is one way in which to support the implementation of P3C. This project provides the innovative and novel approach needed to address these findings and facilitate the measurement and implementation of P3C.
|The Organisational change tool (P3C-OCT) is ready for implementation. There would be a small charge requested from organisations to cover the analytics required for the development of the dashboards, this would cover researcher time and be handled by Plymouth University.
The P3C-PEQ is undergoing minor changes to the scoring methodology following the latest psychometric analysis, but this does not affect the immediate use of the tool. We are planning to develop a dashboard for the PEQ, but this will not be ready until spring 2018 for beta testing.
For both tools we have a good quality normative data set from which other organisations could bench mark their activity and improvement.
|National CLAHRC 021||Stroke Pathway Modelling||The evidence for alteplase is strong with support from NICE appraisal. The challenge is reducing variation in thrombolysis rates between hospitals and maximising potential health gain (as achieved in some UK hospitals). The modelling approach we have developed is supported by evidence of before-after improvements in one hospital in our region which is being replicated. We have also demonstrated that factors other than speed through the acute pathway from arrival to CT scan are not the only determinants (publication in progress).||The approach to model development in Simul8 will require availability of the software and some competence in its use along with access to SSNAP data. Data are routinely sent to all acute stroke services which take part in SSNAP (90%+ of units in the UK).|
|National CLAHRC 022||Patient Initiated Clinics (PIC) in long term conditions.||There is some evidence that patient-initiated appointment systems may be a safe and more efficient method of appointment scheduling for people with long-term conditions in secondary care compared with consultant-led appointment systems. Review 1: The Clinical Effectiveness of Patient Initiated Clinics for Patients with Chronic or Recurrent Conditions Managed in Secondary Care: A Systematic Review Review 2: Patient initiated clinics for patients with chronic or recurrent conditions managed in secondary care: a systematic review of patient reported outcomes and patient and clinician satisfaction
Review 3: Patient-initiated appointment systems for adults with chronic conditions in secondary care (Cochrane review: currently under review)
|National CLAHRC 023||GENIE a social network intervention designed to enhance and diversity support for people with long- term conditions.||This is predicated on evidence of the impact of networks and resources for mobilising support and social involvement and impact on health and wellbeing. Evidence of the positive role social networks have in managing a long-term condition suggested that current self-management initiatives emphasising individual motivation and behaviour change are likely to be enhanced by the development and implementation of strategies for linking people to wider resources through engaging social networks and local support [1,2 ]. Implementation in patient, domestic and community settings is multi-layered requiring a focus on co-production and the implementation of strategies which cross informal and formal healthcare boundaries.|
Research has established that diverse networks are good for health and that having a variety of links and connections are better than networks centred on close family members alone. Social involvement with community organisations can confer more opportunities for aspects of long term conditions management than personal networks for marginalised and disadvantaged groups. Additionally, the service costs for people who received high level of network support are much lower than for people whose network members contribute little to the management of their illness . Use of Genie made healthcare savings of £175 per patient per year with an improvement in health outcomes (blood pressure and quality of life) . On the Isle of Wight we found people took up an average of 3 new activities after use of GENIE . In Dorset it is used as an activity in regular community-based self-management support courses.
|Earlier versions of GENIE have been used on the Isle of Wight as part of their integrated care system with pilots in UK, Canada, US, Spain, Netherlands, Bulgaria and Greece. Feedback from these pilots and recent work with mental health services in the Wessex area have been used to refine and develop the GENIE tool.
We are now in the process of adapting the software and developing it further to aid its scale up and use further across the UK.
It is estimated that only 113 patients need to use Genie for its implementation cost to break even (Cost savings for 113 patients using Genie = £20,000 (cost of basic contract))
The Genie logo and name are going through the Trade Mark registration process, Southampton City Council are to start training up a team of facilitators to help people use Genie across the city (Live by April 2018), and a contract has been drawn up.
|National CLAHRC 024||Implementation of trained mealtime volunteers to help older hospital patients in a range of ward areas (SMART study)||Sixty five volunteers worked more than 800 mealtimes and released nursing time valued at £34,000 over 15 months (band 5 nurse). 251 patients in 5 ward areas had their clinical characteristics recorded highlighting profound anorexia. Our research findings showed that volunteers were a safe option and spent 35-56% time actually feeding patients. The research team has conducted interviews and focus groups with patients, relatives, staff and volunteers. Patients were appreciative of the additional help and enjoyed the opportunity to build a relationship with the volunteers. Volunteers felt appreciated in their role and enjoyed their duties. Comparative work across Wessex shows hospitals that had voluntary meal time did better than those with no system in place.||A critical mass of volunteers have been trained and work on 5 Medicine for Older People wards, 3 acute wards, 2 Trauma and Orthopaedics wards and 2 adult medicine wards.
This scheme has now been adopted by University Hospital Southampton NHS Foundation Trust. There is scope for this approach to be replicated at acute hospitals, community settings and nursing care homes to lessen changes of malnutrition in older people.
Recently the project has received a HelpForce grant of £50k to UHS to develop volunteers further. There is scope to combine the Mealtime Assistant Volunteer work with the SoMove project which trains volunteers as therapists for physical activity on wards, The combined ideas have been adopted by UHS as part of its ‘Eat, Drink, Move’ campaign.
|National CLAHRC 025||GP online consultation systems need to be reconfigured to improve access for patients and reduce GP workload||As part of the GP forward view, £45 million was assigned by NHS England to support practices to purchase and implement online consultation systems which are stated to “improve access and make best use of clinicians’ time.” https://www.england.nhs.uk/gp/gpfv/redesign/gpdp/online-consultations-systems-fund/
NIHR CLAHRC West, in collaboration with the One Care consortium, evaluated a 15-month pilot of eConsult (a platform for submitting consultation requests online) in 36 primary care practices across Bristol, South Gloucestershire and North Somerset, using data from practices showing subsequent actions by the practice, in-depth interviews with staff, patient survey data, and web use statistics.
|The research showed that e-consultations were used primarily during weekdays and practice opening hours (not out of hours as expected). While efficiencies were possible for some simple online requests (such as repeat prescription, fit note), 70% of e-consultations resulted in direct (telephone or face-to face contact) with a clinician, thus duplicating (not reducing) workload. Online systems need to be introduced with care and configured so that they work with existing GP practice systems to avoid duplicating workload and improve access for patients.|
|National CLAHRC 026||Maintaining patient safety in the crowded Emergency Department (ED) – implementing the ED safety checklist.||After an initial pilot, the EDSC was rolled out across 10 EDs in the West of England with the support of the West of England Academic Health Sciences Network, and NIHR CLAHRC West conducted a mixed methods evaluation of its impact and use – data are currently being analysed.
Key performance indicator metrics have been collected; analysis will be complete by December 2017. Preliminary analysis of qualitative data indicates that the EDSC can provide support for ED staff and serve as a reminder/facilitator of communication for escalation and handovers. However, consistent and optimal use of the EDSC was linked to factors including: multi-professional leadership, regular feedback to staff, and integration with existing documentation/systems.
|NHS Improvement is urging the implementation of this or an equivalent EDSC now.
CLAHRC West has a preliminary set of recommendations prepared that could be shared with AHSNs and EDs. The research analysis and write-up will be complete by December 2017, and so a more comprehensive package of evidence will be submitted for publication and available in January 2018.
|National Project 027||Rolling out the National Early Warning Score (NEWS) outside the acute hospital setting||Early indications are that roll-out of NEWS may be warranted in some pre-hospital settings to ensure the sickest patients are treated quickly in the most appropriate setting. The repurposing of NEWS to other settings, or to patients who are not acutely unwell, is more questionable. There are likely to be barriers to the implementation of NEWS in primary care.||NEWS may be mandated by NHS I. The findings from CLAHRC West research will be able to signpost where and how NEWS could be strengthened in these settings. We anticipate final study results being available January 2018. Materials to assist implementation will then need to be developed.|
|National Project 028||Rolling out low dead space syringes for people who inject drugs to reduce blood borne virus transmission||The risk of passing blood borne viruses among people who inject drugs is influenced by the type of injecting equipment they use. Low dead space syringes reduce the chance of spreading HIV and HCV if they are shared or re-used. Our research showed that this equipment is likely to be acceptable to people who inject drugs, but that implementation needs to be supported with additional materials and training to reflect local variations in the supply and use of illegal drugs.||The production of materials to support implementation will be available in October 2018. These resources will include harm reduction infographics for people who inject drugs and NSP staff, accompanying training materials and evidence for policy makers; and evidence about how to communicate key messages within these materials in a way that changes practice and reduces harms associated with injecting drug use.|
|National Project 029||Patient Initiated Clinics (PIC) in chronic disease||Patients with chronic fluctuating conditions comprise a large proportion of those seen in hospital outpatients. Systematic reviews report no indication of harm or increased costs and some patchy evidence of potential benefits in the form of greater patient satisfaction.
Review 1: The Clinical Effectiveness of Patient Initiated Clinics for Patients with Chronic or Recurrent Conditions Managed in Secondary Care: A Systematic Review
Review 2: Patient initiated clinics for patients with chronic or recurrent conditions managed in secondary care: a systematic review of patient reported outcomes and patient and clinician satisfaction
|National Project 030||Development and validation of electronic Frailty Index (eFI)||No direct evidence of health gain.|
Use of an electronic Frailty Index allows general practices to identify and prioritise frail patients for intervention.
|The eFI has been incorporated NICE Guidelines on Multimorbidity: clinical assessment and management [NG56] (September 2016)|
It has also been included in guidance to GPs on routine frailty identification and frailty through the GP Contract 2017/2018.
|National Project 031||STarTBack lower back pain screening tool||The published evaluation showed that the STarT Back approach reduced healthcare costs with an average saving of £34.30 per patient. Modelling this for implementation, with nationally available benchmark data per 1,000 patients referred to physiotherapy, the current cost of service provision for community physiotherapy is estimated at £224,000 per 1,000 new referrals. These costs demonstrate a minimum saving of £61,000 per 1,000 patients referred and represent the direct costs associated with physiotherapy services. Audit of implementation sites show that physiotherapy services are not utilising 5 follow ups for high-risk patients, with the average being 3 follow-up appointments, the figures quoted above are, therefore, conservative estimates of savings per 1,000 patients. The STarT Back Trial identified broader health and social care savings including: reduction in the number of GP consultations, reduction in the number of visits to NHS consultants, reduced investigations (MRI/x-rays), reduction in epidural injections and medication usage. No attempt has been made to quantify the reduction in these costs as part of this model.
Whitehurst DG, Bryan S, Lewis M, Hill J, Hay EM. Exploring the cost-utility of stratified primary care management for low back pain compared with current best practice within risk-defined subgroups. Ann Rheum Dis. 2012;71(11):1796-802. DOI: 10.1136/annrheumdis-2011-200731.
The evidence base is sufficiently robust that the tool has been adopted in to the lower back pain guidelines by NICE in November 2016.
|CLAHRC Yorkshire and Humber|
|National Project 032||The Achieve Behaviour Change (ABC) approach to patient safety.||We have evidence that this approach has improved patient safety, supports cost saving to the NHS, and can harness clinical problem solving to develop a patented technology solution. For example one project developed and implemented the ABC approach when applied to pH testing for correct nasogastric (NG) tube placement. Based on our evaluation of this project across four hospital Trusts, health economists calculated that increased use of the recommended pH testing method led to a reduction in the use of x-rays from 55% to 24% of occasions when a naso-gastric tube was placed. The estimated net savings per participating hospital in the first year were £29,573 rising to £57,205 in subsequent years, and £1M and £1.94M respectively across the region. An additional significant outcome is that we have developed (currently testing and patenting) a new portable device which will give an accurate check of NG-tube position.
Five patient safety projects are using the ABC approach to support their work including:
Increasing cancer referrals in general practice (Scarborough and Rydale CCG)
Implementation of the safer surgery checklist (Hull acute Trust)
Patient flow (regional footprint),
Acute Kidney Injury (AKI) reduction (Leeds and Bradford acute Trust)
Patient safety huddles (regional footprint).
|Yes. We have already delivered behaviour change training to some 500 people from all acute Trusts in Yorkshire and Humber, as well as GP practices, care homes and community organisations. Members of the theme continue to work alongside Improvement Academy colleagues to deliver ABC Workshops (19 to date), which enable self-selecting participants to apply the ABC approach to tackle a wide variety of priorities within their Trusts. NHS England has commissioned this training at a national level (three national workshops have been delivered to date). The approach is also being implemented internationally as part of a New South Wales Translational Cancer Research Network funded project in Australia. This approach also underpins our patient safety work within the Patient Safety Translational Research Centre.|
|National Project 033||Enhanced Community Palliative Support Service (EnComPaSS)||A cohort of community-based nurses (AfC band 5) managed and mentored by hospice-based specialist palliative nurses (AfC band 7) began using the system in 2016. During the initial evaluation period, March to September 2016, 1501 patients received 3,285 home visits supported by this approach. During this period:
o Hospice patients admitted to hospital reduced from 1238 to 1156 (-6.62%);
o Total hospital admissions for this cohort reduced from 5771 to 4548 (-21.19%);
o Hospital admissions per hospice patient reduced from 4.66to 3.93 admissions (-5.67%); and
o Length of stay per admission reduced from 6.23 days to 5.99 days (-3.85%); so
o Assuming the PSSRU rate of £371 per acute bed day (Unit Costs of Health and Social Care 2015), for the 1156 patients admitted to hospital, this translates into estimated savings of £2,418,860.64 per year.
An evaluation of the outcomes for a twelve month period following the ‘bedding-in’ of the service is nearing completion and the results, which show improvement from the initial evaluation, will be submitted for publication shortly.
|This approach is ready for implementation without further revision.|
|National Project 034||Recovering Quality of Life (ReQoL).||The quality of life of service users should have a central role in the recovery journey they undertake. One way to create a positive recovery environment is to provide a voice to service users and this is the aim of ReQoL. ReQoL enables service users to self-report on what matters most to them and provide them to evaluate their progress on the recovery journey. By doing so, ReQoL offers an opportunity for service users to feel in control of what happens with their treatment and recovery
ReQoL can be used to aid assessment and to guide goal setting and care planning. ReQoL can be used for weekly or regular monitoring. It can also be used within the session to review progress.
A case study outlining the implementation of ReQoL in adult mental health services in Leeds and York Partnership NHS Foundation Trust can be seen here: http://www.reqol.org.uk/p/case-study.html
|Yes, ReQoL has been implemented in mental health services across England. Oxford University Innovation is overseeing licences for ReQoL and have reported that licences have been granted to 80 organisations, including: 28 English Mental Health Trusts and 15 Universities.|
|National Project 035|
Development, validation and national implementation of the electronic frailty index (eFI)
|We have established a Healthy Ageing Collaborative (HAC) to support the development of new, evidence-based models of care for older people with frailty using the eFI as part of the Yorkshire & Humber AHSN Improvement Academy. To date, the HAC has engaged with 75 of the 209 CCGs in England to develop new models of care at a practice and population level.
Examples of the interventions deployed in primary care after identifying people with frailty using the eFI include:
A stratified, integrated, whole systems approach to care for older people using the eFI (NHS West London CCG)
Medication reviews for people with severe frailty and care home residents (NHS Vale of York CCG)
Proactive falls prevention interventions for people with moderate frailty (NHS Leeds South & East CCG)
Adding people with severe frailty to practice palliative/Gold Standards Framework registers and offering advance care planning interventions (NHS Airedale, Wharfdale & Craven CCG)
Use of the eFI is supported in the 2016 NICE multimorbidity guideline, and the eFI is included as a recommended tool in the 2017/18 GP General Medical Servcies (GMS) contract, which includes identification and management of frailty as a new contractual requirement.
|The eFI is available in all the leading primary care electronic health record systems in the UK. We have taken an innovative approach to licensing of the eFI to providers of electronic health record systems. The eFI is licensed on terms stating that it is freely available to UK EHR providers on the basis that the licensor will not charge any additional premium to its end user for use of the eFI. This means that the eFI will remain freely available for use in routine care at no additional cost to the NHS or the social care sector.
The eFI has been awarded the 2017 RCP Excellence in Patient Care Award for Innovation and the 2016 EHI Healthcare IT Product Innovation award, providing further evidence that our approach is highly innovative.
|CLAHRC East of England|
|National Project 036||Improving Outcomes for People with First Episode Psychosis||The Access and Waiting time standards start the clock when the referral is received anywhere within the mental health trust rather than at the point of referral to EIP.
Evidence from CLAHRC West Midlands demonstrated that treatment delay could also be reduced by using a youth care pathway within adult services for people aged up to 25years; thus, reducing the duration of untreated psychosis DUP.
CLAHRC Oxford undertook a health economic evaluation which demonstrated that FEPs within EIP services compared to standard treatment pathways spent on average 15 days fewer in inpatient services, were twice as likely to be employed and 1.5 likely to be housed in independent living. This translates to an NHS annual cost saving of £4,031 per person treated with EIP with an estimated NHS saving of £33.8 million per year. When taking into account, welfares and productivity gain, the cost saving to the economy could be £57.5 million per year if EIP were fully implemented.
CLAHRC East of England developed an on-line PsyMaptic prediction tool to provide incidence prediction for each locality across England. This has directly informed commissioning and workforce development plans across the country.
|As one of the few evidence-based service developments in mental health a progress review and development of plans to retain advantages would be beneficial.|