Older adults aged 65 years and above have a disproportionately higher utilization of emergency he... more Older adults aged 65 years and above have a disproportionately higher utilization of emergency healthcare, of which Emergency Department (ED) visits are a key component. They tend to require more extensive workup, therefore spending a greater amount of time in the ED. The rise in the older adult population globally may contribute to worsening overcrowding in many EDs. When older adults visit the ED, they are at higher risk of hospitalisation and adverse events compared to younger patients. Following discharge from the ED, older adults often experience functional decline and reduction in mobility, which may not improve within a year. In this paper, we present a protocol for a systematic review of the determinants of ED utilisation among community-dwelling older adults aged 65 years and above, applying Andersen and Newman's model of healthcare utilisation. Furthermore, we aim to present other conceptual frameworks for healthcare utilisation and propose a holistic approach for understanding the determinants of ED utilisation by older persons. The protocol is developed in accordance with the standards of Campbell Collaboration guidelines for systematic reviews, with reference to the Cochrane Handbook for Systematic Review of Interventions. Medline, Embase and Scopus will be searched for studies published from 2000 to 2020. Studies evaluating more than one determinant for ED utilisation among older adults aged 65 years and above will be included. Search process and selection of studies will be presented in a PRISMA ow chart. Statistically signi cant (p < 0.05) determinants of ED utilisation will be grouped according to individual and societal determinants. Quality of the studies will be assessed using Newcastle Ottawa Scale (NOS). In Andersen and Newman's model, individual determinants include predisposing factors, enabling and illness factors, and societal determinants include technology and social norms. Additional conceptual frameworks for healthcare utilisation include Health Belief Model, Social Determinants of Health and Big Five personality traits. By incorporating the concepts of these models, we hope to develop a holistic approach of conceptualizing the factors that in uence ED utilisation among older people. This protocol is registered on 8 May 2021 with PROSPERO's International Prospective Register of Systematic Reviews but pending con rmation.
Assessing the Landscape and Future Actions for Quality Improvement in the Veterinary Sector: The Insights, Expectations and Aspirations of the Profession
Healthcare systems with limited resources face rising demand pressures. Healthcare decisionmakers... more Healthcare systems with limited resources face rising demand pressures. Healthcare decisionmakers increasingly recognise the potential of innovation to help respond to this challenge and to support high-quality care. However, comprehensive and actionable evidence on how to realise this potential is lacking. We adopt sociotechnical systems and innovation systems theoretical perspectives to examine conditions that can support and sustain innovating healthcare systems. We use primary data focussing on England (with 670 contributions over time) and triangulate findings against globally-relevant literature. We discuss the complexity of factors influencing an innovating healthcare system's ability to support the development and uptake of innovations and share practical learning about changes in policy, culture, and behaviour that could support system improvement. Three themes are examined in detail: skills, capabilities, and leadership; motivations and accountabilities; and collaboration and coordination. We also contribute to advancing applications of sociotechnical systems thinking to major societal transformation challenges.
Last but by no means least, a number of individuals contributed to the study by arranging and par... more Last but by no means least, a number of individuals contributed to the study by arranging and participating in interviews, surveys, fidelity reviews and observations of Communities of Practice. We wanted to express our special thanks to the IPS Grow team (led by Lynne Miller) for their collaboration and introductions to many IPS providers. We also thank all those from IPS services across England who took part in interviews, surveys, observations and fidelity reviews for this evaluation.
The NHS is under increasing pressure to meet rising and changing demand for healthcare services, ... more The NHS is under increasing pressure to meet rising and changing demand for healthcare services, driven in part by an ageing population and growing numbers of people living with chronic conditions. It confronts these demands with limited resources. Policymakers are increasingly recognising the potential of innovation to support a thriving health and care system (for example as seen in the Accelerated Access Review, Carter Review, Next Steps on the NHS Five Year Forward View, Life Sciences Industrial Strategy and the NHS Long Term Plan, among other policy documents). Adopting innovative technologies, products and services offers the NHS the opportunity to help respond to the challenges it faces and to support high-quality, efficient and effective healthcare. However, both policymakers and wider stakeholders often lack the appropriate information, evidence, capabilities, resources, relationships, incentives and accountabilities to inform policy and practice, and the development, commissioning and use of innovations remains patchy across England. Some proven innovations swiftly spread while others with equal promise get limited traction. 1 NIHR study PR-R7-1113-22001; IRAS: 193979. The research received ethical approval from the University of Manchester, where one of the study principal investigators is located.
Huddersfield Research Portal (University of Huddersfield), Jun 1, 2016
Background: The use of pain assessment tools with patients with advanced dementia is widely recom... more Background: The use of pain assessment tools with patients with advanced dementia is widely recommended in healthcare policy but their impact on clinical outcomes for dying patients is unclear. Healthcare assistants have a significant role in caring for the dying but their contribution to pain recognition is unexplored. Aims: Explore nurses' use of pain assessment tools with patients dying with advanced dementia in hospice, secondary and nursing home care settings. Investigate the role of healthcare assistants in pain assessment. Methods: Semi-structured, face-to-face interviews were conducted with 24 nurses and 14 healthcare assistants. Thematic analysis of verbatim transcripts was used to identify emergent themes. Three researchers confirmed final themes. Results: The Abbey Pain Scale formed part of the pain assessment protocol for nurses across care settings but most reported challenges in using it with dying patients. Scores based on brief observation were perceived as a poor substitute for knowledge of the patient, observation over time and collateral history from healthcare assistants and family. Most nurses reported pain tools resulted in no measurable clinical outcomes for patients nearing death. Healthcare assistants described methods of recognising and reporting pain and their role in observing for treatment response and side effects. Nurses and healthcare assistants described mixed experiences discussing pain with physicians. Conclusion: Nursing staff described challenges with integrating pain assessment tools in practice and preferred patient knowledge, observation and collateral history from family and healthcare assistants to assess pain. The contribution of healthcare assistants in recognising and reporting pain and in assessing treatment response is described. These findings have important implications for health policy, nurse education and healthcare provision.
This article describes a review of the Biomedical Research Units (BRU) scheme, undertaken for the... more This article describes a review of the Biomedical Research Units (BRU) scheme, undertaken for the Department of Health. This review was a perceptions audit of senior executives involved in the scheme, and explored what impact they felt the scheme is having on the translational research landscape. More specifically, we investigated whether and how institutional relationships between NHS and academic partners, industry and other health research system players are changing because of the scheme; how the scheme is helping build critical mass in specific priority disease areas; and the effects of any changes on efforts to deliver the broader goals set out in Best Research for Best Health. The views presented are those of study informants only. The information obtained through our interviews suggests that the BRU scheme is significantly helping shape the health research system to pursue translational research and innovation, with the clear goal of realising patient benefit. The BRUs are already contributing to observable changes in institutional relationships between the NHS and academic partners: trusts and medical schools are collaborating more closely than in the past, have signed up to the same vision of translational research from bench to bedside, and are managing and governing targeted research resources more professionally and transparently than in the past. There is also a stronger emphasis on engaging industry and more strategic thinking about strengthening regional and national collaboration with other hospital trusts, PCTs, research organisations, networks and development agencies. The scheme is also transforming capacity building in the health research system. This includes (i) developing and modernising facilities and equipment for translation; (ii) building a critical mass of human resources through recruitment and training, as well as improving retention of existing expertise; and (iii) helping ensure a steady flow of funds needed to sustain research activity and accelerate movement through the innovation pipeline. A number of centres are also trying to recreate the BRU model in new disease areas, with their own resources.
Background A strong focus on individual choice and behaviour informs interventions designed to re... more Background A strong focus on individual choice and behaviour informs interventions designed to reduce health inequalities in the UK. We review evidence for wider mechanisms from a range of disciplines, demonstrate that they are not yet impacting on programmes, and argue for their systematic inclusion in policy and research. Methods We identified potential mechanisms relevant to health inequalities and their amelioration from different disciplines and analysed six policy documents published between 1976 and 2010 using Bacchi's 'What's the problem represented to be?' framework for policy analysis. Results We found substantial evidence of supra-individualistic and relational mechanisms relevant to health inequalities from sociology, history, biology, neuroscience, philosophy and psychology. Policy documents sometimes expressed these mechanisms in policy rhetoric but rarely in policy recommendations, which continue to focus on individual behaviour. Discussion Current evidence points to the potential of systematically applying broader thinking about causal mechanisms, beyond individual choice and responsibility, to the design, implementation and evaluation of policies to reduce health inequalities. We provide a set of questions designed to enable critique of policy discussions and programmes to ensure that these wider mechanisms are considered.
RAND Europe is an independent, not-for-profit research organisation whose mission is to improve p... more RAND Europe is an independent, not-for-profit research organisation whose mission is to improve policy and decision making for the public good. RAND's publications do not necessarily reflect the opinions of its research clients and sponsors. R ® is a registered trademark.
Strengthening the contribution of improvers to UK health and care? An evaluation of the Q Initiative 2016–2020
RAND Europe has been a 'critical friend' of Q from 2016 to 2020. The first two years of t... more RAND Europe has been a 'critical friend' of Q from 2016 to 2020. The first two years of this evaluation were primarily formative in approach, focusing on how Q was designed and established, and feeding the data back to the Q team to inform the ongoing design of Q. The later stages of the evaluation took a more summative approach, focusing on the impact of Q on its members as well as on its wider contributions to healthcare improvement.
is a not-for-profit research organisation that helps to improve policy and decision making throug... more is a not-for-profit research organisation that helps to improve policy and decision making through research and analysis. RAND's publications do not necessarily reflect the opinions of its research clients and sponsors. All rights reserved. No part of this book may be reproduced in any form by any electronic or mechanical means (including photocopying, recording, or information storage and retrieval) without permission in writing from the sponsor.
is an independent, not-for-profit policy research organisation that aims to improve policy and de... more is an independent, not-for-profit policy research organisation that aims to improve policy and decisionmaking in the public interest through research and analysis. RAND's publications do not necessarily reflect the opinions of its research clients and sponsors. All rights reserved. No part of this book may be reproduced in any form by any electronic or mechanical means (including photocopying, recording, or information storage and retrieval) without permission in writing from the sponsor.
Talking Policy: An examination of public dialogue in science and technology policy
This report makes recommendations for how public consultation can be fed into policy debates in s... more This report makes recommendations for how public consultation can be fed into policy debates in science and technology. The UK based study draws from four case studies and a twenty-two respondent web survey. The case studies were the public dialogue activities run for the ...
International Journal of Integrated Care, Sep 27, 2010
In response to concerns that the needs of the aging population for well-integrated care were incr... more In response to concerns that the needs of the aging population for well-integrated care were increasing, the English National Health Service (NHS) appointed 16 Integrated Care Pilots following a national competition. The pilots have a range of aims including development of new organisational structures to support integration, changes in staff roles, reducing unscheduled emergency hospital admissions, reduced length of hospital stay, increasing patient satisfaction, and reducing cost. This paper describes the evaluation of the initiative which has been commissioned. A mixed methods approach has been adopted including interviews with staff and patients, non-participant observation of meetings, structured written feedback from sites, questionnaires to patients and staff, and analysis of routinely collected hospital utilisation data for patients/service users. The qualitative analysis aims to identify the approaches taken to integration by the sites, the benefits which result, the context in which benefits have resulted, and the mechanisms by which they occur. The quantitative analysis adopts a 'difference in differences' approach comparing health care utilisation before and after the intervention with risk-matched controls. The qualitative data analysis adopts a 'theory of change' approach in which we triangulate data from the quantitative analysis with qualitative data in order to describe causal effects (what happens when an independent variable changes) and causal mechanisms (what connects causes to their effects). An economic analysis will identify what incremental resources are required to make integration succeed and how they can be combined efficiently to produce better outcomes for patients. This evaluation will produce a portfolio of evidence aimed at strengthening the evidence base for integrated care, and in particular identifying the context in which interventions are likely to be effective. These data will support a series of evaluation judgements aimed at reducing uncertainties about the role of integrated care in improving the efficient and effective delivery of healthcare.
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