NHS Digital Data Release Register - reformatted

Rand Europe

Project 1 — DARS-NIC-07173-T8S5M

Opt outs honoured: N

Sensitive: Non Sensitive

When: 2016/12 — 2017/02.

Repeats: One-Off

Legal basis: Health and Social Care Act 2012

Categories: Anonymised - ICO code compliant

Datasets:

  • Hospital Episode Statistics Admitted Patient Care
  • Hospital Episode Statistics Accident and Emergency
  • Hospital Episode Statistics Outpatients

Benefits:

SLIC: This study has been commissioned by the King's Health Partners in order to determine the effectiveness of their Southwark and Lambeth Integrated Care Programme, focusing on the older people programme. RAND Europe therefore want to be able to use the data to measure changes in admission of older people to A&E and a number of other outcomes in order to be able to meet the needs to the SLIC team. King's Health Partners commissioned the evaluation as it considers it is of fundamental importance that it robustly tests its impact on the quality and value of the health and social care system. The evaluation will serve the following purposes: - to provide assurance for local people, participating organisations and sponsors on the extent of impact and that this assessment of impact is independent and robust; - to inform local decisions on the spread and application of integrated care; - to highlight areas of success and areas for learning and improvement locally to share learning with the health and social care system nationally. The evaluation has both direct benefits for the King's Health Partners, as well as the potential for wider learning as this is one of the first major scheme of its kind 'integrating care' in the UK. The use of HES data will help RAND in fulfilling its mission which is to improve health and health care systems, by providing policymakers with objective, empirically based research to inform their decision making. RAND Europe are contracted to submit annual reports with a final report due in summer 2017. Following the first annual report being submitted for review by the SLIC Evaluation Steering Group and by the King's Health Partners, it has been identified that the level of activity was lower than anticipated during the first two years of SLIC. Future analysis based on more recent data is needed for to be able to understand whether efforts to increase the uptake of the intervention have had a measurable impact. TELE-FIRST: RAND Europe would also present findings at national and international conferences, including the annual NHS Confederation conference and the HSRN conference. The findings will enable providers and policy makers to assess if such an approach should be advocated in their locality and whether it would be appropriate for all types of patient. The study focuses on evaluating the telephone triage approach in a group of practices willing to adopt use of a telephone triage system. If the findings support the use of the new approach, the work will show how the approach could be rolled out to a wider group of GP practices, what the potential barriers would be, and how these barriers might be overcome. There are major potential benefits of the new approach to consultations in terms of improved access to GPs, reduced waiting times, improved continuity of care, and reduced workload for GP practices. RAND Europe are contracted to submit a final report in spring 2017.

Outputs:

Only aggregate analysis with small numbers suppressed, in line with HES analysis guide, will be made available to any third party. SLIC: The confirmed output is an annual written report produced for the SLIC Evaluation Steering Group. These will be made publically available through the SLIC, RAND and the University of Cambridge's respective websites. Additionally RAND Europe will produce articles for publication in academic journals and present at conference (poster or oral presentations). The first annual report has been produced and is currently under review by the SLIC Evaluation Steering Group and by the King's Health Partners. Analysis will be conducted annually up until June 2017. The findings and detailed methodology will be made publically available through RAND Europe, the University of Cambridge and SLIC websites. The interim analysis will inform the SLIC older people's programme as it progresses and it is intend that the final analysis will form the basis of reviewed academic publications. TELEFIRST: The outputs from the research will have three principle audiences: policy makers; NHS managers in primary care; and academic audiences. RAND Europe will publish findings in academic peer-reviewed journals and present findings at academic conferences. RAND Europe will seek to actively engage policy makers at local and national level, along with local service managers, NHS providers, researchers, patient groups and other stakeholder groups that the applicant believes would be the beneficiaries of the proposed research. Written outputs would include articles in peer reviewed journals as well as a final report as outlined by the NIHR Health Services and Research Development programme (due March 2017). A summary of the findings of the research and recommendations will be provided in a four page briefing document. This summary will be targeted to policy makers and practitioners. Patient and public involvement (PPI) members will be asked to assist in the production of a short summary for a nontechnical audience. RAND Europe would also present findings at national and international conferences, including the annual NHS Confederation conference and the HSRN conference. The outputs for both studies are to be made available to all relevant stakeholder and this is likely to include the British Medical Association and the Royal College of General Practitioners. The chair of the NHS Primary Care Workforce Commission Professor Roland (PI of the project) has strong links to the policy community and will ensure that the research is shared with the relevant audiences.

Processing:

Raw data received by RAND Europe will be stored and managed by the Information Controller for RAND Europe. All individuals will access to the data are substantive employees of RAND Europe or the University of Cambridge. The data will only be accessed by these staff on a need to know basis and for the purpose of the two studies detailed in this agreement. Pre-processing will include the following: linking episodes to create a dataset delineated by admissions; for each practice the data will then be aggregated into 5 year age groups separately for each gender. Aggregated data will then be analysed RAND Europe and the University of Cambridge team. Data aggregated and anonymised by practice, age and gender will then be linked at practice level to other datasets held by the University of Cambridge and used in statistical analyses. The other datasets (none at patient level) are: - GP Patient Survey data obtained from the Department for Health and NHS England; - Practice level Deprivation Scores obtained from the Association of Public Health Observatories (Now Public Health England) - GP Census data obtained from HSCIC - Quality Outcomes Framework data obtained from the HSCIC website - Other freely available practice level indicators obtained from the NHS Digital Indicator Portal No data linkage to record level data will occur for either the SLIC or Tele-First studies. SLIC: RAND Europe will model the level of demand for services recorded in the HES data, aggregated at practice level. Some condition and cause specific outcomes (e.g. falls) will also be included in later analyses. A comparison will be made between practices involved in the SLIC intervention against a selection of matched practices from around the country. The model will include data before the intervention, including random effects so that the underlying admission rate in each practice is accounted for and that this rate can change year on year. An interaction term between years (following intervention) and intervention group allows for the assessment of the effect of the intervention. The annual analysis will follow the same format as that used in the practice based analysis of the national integrated care pilots [Roland M et al. Case management for at-risk elderly patients in the English integrated care pilots: observational study of staff and patient experience and secondary care utilisation. international Journal of Integrated Care 2012; 12] Outcomes are used to assess changes in hospital utilisation following implementation of the Older People's Programme. Changes in hospital utilisation will be assessed using changes in emergency admissions, elective admissions, bed days, A&E attendance and outpatient attendance. In order to place these changes in context, changes in hospital utilisation within Southwark and Lambeth will be compared to similar populations in South London and the rest of England. TELE-FIRST: RAND Europe and University of Cambridge will conduct analyses to compare A&E attendance, outpatients attendance and emergency admissions between study practices and control practices in England. The analysis will be based on a before-and-after difference-in-differences analysis allowing for baseline and pre-intervention trends and controlling for practice size, rurality, deprivation, and population age/sex/ethnicity. It is anticipated that data covering a period of up to three years prior to and up to two years post introduction of the triage system will be sufficient to support the analyses. In these models practice level random effects with an unstructured covariance matrix will be included for each year so that the underlying outcome level (and associated clustering/over dispersion) in each practice is incorporated and may change each year. An interaction term between year (following intervention) and intervention group allows us to assess the effect of the introduction of the triage system in each of the two years following intervention. Where possible, a second set of models will model intervention effects with monthly data. These models will be similar but further include a spline approach that models both sudden and gradual changes using interactions between the intervention group and (1) a post intervention indicator and (2) a linear year variable that begins at the intervention, respectively). When analysing secondary care usage a mixed effects Poisson regression will be used to model the count of admissions. For each practice data will be aggregated into 5-year age by gender groups and the rate of admissions will be modelled using freely available data on the age and gender profiles of the practice population. In doing so the applicant will be able to adjust for patient level age and gender and will further adjust for the same practice level variables as listed above.

Objectives:

RAND Europe and the Health Service Group at the University of Cambridge have been commissioned to undertake two research projects on behalf of NHS organisations. These are SLIC (Southwark and Lambeth's Integrated Care) and TELE-FIRST. No data will be shared with a third party. SLIC Southwark and Lambeth's Integrated Care (SLIC) focuses specifically on the Older Peoples' Programme (OPP). The project was commissioned by King's Health Partners (Guy's and St Thomas' NHS Foundation Trust & King's College Hospital NHS Foundation Trust) as part of the 'Evaluation of Lambeth and Southwark Integrated Care Pilot Scheme. The evaluation focuses on outcomes (hospital and nursing home utilisation) and cost effectiveness. The HES data is needed to understand the impact of the OPP on hospital utilisation (e.g. admissions, emergency admissions, outpatient attendance and A&E attendance). The study is a controlled before and after design and comparisons will be made with similar populations in south London and the rest of England. The study will compare results at the GP practice level - e.g. to compare responses for all over 65s or all over 75s in Lambeth and Southwark practices with matched practices in other parts of the country. Initiated in 2012, the SLIC OPP brings together health and social care providers and local people to help maximise the health and independence of older people, aged 65 years and older, through: - better identification and management of risk; - minimisation of inappropriate hospital use in times of crisis through faster access to special assessment, rapid support at home and improved discharge programmes. The programme focuses on holistic care for the population rather than a single disease, across physical and mental health, and social care in two boroughs. A formative and summative evaluation was commissioned to run in parallel to the programme from August 2012. The formative evaluation is to be undertaken while the programme activities are in progress to help monitor how well the aims and objectives are being implemented. The summative component focuses on outcomes to enable SLIC to understand whether the programme has achieved its aims and objectives at the end of the programme. The summative component will report in summer 2017. The evaluation consists of four components: -People's views; -Outcomes; -Cost effectiveness; -Change Process. TELE-FIRST The Tele-first study, is to reuse the data currently processed under the existing agreement. Tele-first aims to explore the benefits and disadvantages of telephone triage in general practice. Telephone triage is an innovative approach used in general practice to manage patients' requests to see a doctor. Patients who ask for a face-to face appointment are asked to speak to a doctor on the phone first. The doctor then decides whether and when the patient needs to be seen in surgery, or whether the issue can be dealt with by phone. Management support for this innovation is being offered by two commercial organisations and reported gains include: - the ability to deal with two thirds of requests by telephone; - to greatly reduced waiting times for appointments; - improved continuity of care; - improved patient experience and reduced A&E attendance and emergency admissions. This study fulfils a need for independent research to better understand its impact on staff and patients and to evaluate whether it is feasible and cost effective. In this study, researchers at RAND Europe and the University of Cambridge, (with funding from the National Institute of Health Research) will work together to evaluate the impact of the approach scheme. The study began in September 2014 and will run for two and a half years, ending in February 2017. It involves the use of quantitative and qualitative methods and cost-consequences analysis to address the following research questions: 1. How does a GP telephone triage approach affect patient experience and use of primary and secondary care services? 2. What is the impact of GP telephone triage on the nature of consultations for patients and staff, and how appropriate is this approach for hard-to-reach groups? 3. What are the cost consequences of a telephone triage approach in general practice? Study methods include primary data collection using surveys of: - patients regarding their experience of the service; - practice managers on telephone triage use/costs; - qualitative interviews with GPs, practice staff and patients; - quantitative analysis of secondary data including data from the English GP Patient Survey, data on the proportion of patients who leave a practice without changing address and data on hospital utilisation. The HES data are needed to understand the impact of the telephone triage approach on hospital utilisation (e.g. A&E attendance, outpatient referrals, elective admissions and emergency admissions). The analysis of healthcare utilisation data will be based on a before-and-after difference-in-differences analysis comparing practices involved in the study with other practices in England. The analyses will allow for baseline and pre-intervention trends and controlling for practice size, rurality, deprivation, and population age/sex/ethnicity.