Source: Health and wellbeing boards: Making them work – The King’s Fund.
Health and wellbeing boards: Making them work
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Daily Archives: September 23, 2011
Obesity Reviews available via NHS Bolton Library
Obesity Reviews – Wiley Online Library.
NHS Bolton LIbrary now offers Obesity Reviews electronically via Athens! It is for a 12 month trial period to assess feasability. You can access via NHS Evidence or the above direct link
Local NHS bodies to get more say over IT
The NHS national IT system is “not fit” to provide the computer services needed by the health service in England, a government review has said
Health Impact Assessment: Principles and Practice
Source: Health Impact Assessment: Principles and Practice.
An NHS Athens account may be required to view this in full.
Introduction: Every public health student is taught that health is determined by the economic, physical and social environment people live in, much more than by healthcare services for people who are already sick. So if we want to improve health we need to work ‘upstream’ to address these determinants using inter-sectoral action. But how can we turn that rhetoric into reality? What does it mean to work ‘upstream’? How can we work practically with colleagues in other sectors? How can we influence non-health plans and policies in order to improve health? Health impact assessment (HIA) has developed over the last two …
Senior Lib Dem peer wants more ‘teeth’ for HealthWatch
Source: Senior Lib Dem peer wants more ‘teeth’ for HealthWatch | News | Health Service Journal.
This article is solely the work of the HSJ. For a full copy of the article please contact the library
The Liberal Democrat health spokesman in the Lords has called for the Health Bill to be amended to give HealthWatch more “teeth”.
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Flu shots: Emergency stockpile of vaccines set up
An extra two million flu vaccines have been ordered and an emergency “shot-pile” is being set up as health officials prepare for the flu season
via BBC News – Flu shots: Emergency stockpile of vaccines set up.
GPs ‘anxious’ about conflicts of interest in commissioning, says doctors regulator
This article is solely the work of the HSJ. For a full copy of the article please contact the library.
GP commissioners should tell a patient if budgets or referral policies mean he or she cannot access healthcare, and also raise the issue with their commissioning group, the doctors regulator has said.
Blood test for motor neurone disease
Blood test for motor neurone disease – Health News – NHS Choices.
NHS Choices examines the science behind the newspaper headlines.
Links to the headlines
Family help Cardiff Uni find motor neurone disease gene. BBC News, September 22 2011.
Blood test for inherited motor neurone disease ‘in months’. The Daily Telegraph, September 22 2011
Links to the science
Renton AE, Majounie E, Waite A, et al. A hexanucleotide repeat expansion in C9ORF72 is the cause of chromosome 9p21-linked ALS-FTD. Neuron September 21 2011
Sixty hospitals face ‘collapse’ over PFI deals, admits Lansley
Source:Sixty hospitals face ‘collapse’ over PFI deals, admits Lansley | News | Health Service Journal.
This article is solely the work of the HSJ. For a full copy of the article please contact the library.
More than 60 hospitals can not afford the rising cost of private finance initiative schemes and are being left “on the brink of financial collapse”, according to the health secretary
BMA rules out pensions action ‘at this point’
Source: BMA rules out pensions action ‘at this point’ | News | Health Service Journal.
This article is solely the work of the HSJ. For a full copy of the article please contact the library.
Doctors’ leaders have ruled out industrial action “at this point” in the bitter dispute over public sector pensions despite voicing support for the TUC’s day of action in November.
Random variation and rankability of hospitals using outcome indicators
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Abstract
Objective There is a growing focus on quality and safety in healthcare. Outcome indicators are increasingly used to compare hospital performance and to rank hospitals, but the reliability of ranking (rankability) is under debate. This study aims to quantify the rankability of several outcome indicators of hospital performance currently used by the Dutch government.
Methods From 52 indicators used by the Netherlands Inspectorate, the authors selected nine outcome indicators presenting a fraction and absolute numbers. Of these indicators, four were combined into two, resulting in seven indicators for analysis. The official data of 97 Dutch hospitals for the year 2007 were used. Uncertainty in the observed outcomes within the hospitals (within hospital variance, σ2) was estimated using fixed effect logistic regression models. Heterogeneity (between hospital variance, τ2) was measured with random effect logistic regression models. Subsequently, the rankability was calculated by relating heterogeneity to uncertainty within and between hospitals (τ2/(τ2 +median σ2)).
Results Sample sizes varied but were typically around 200 per hospital (range of median 90–277) with a median of 2–21 cases, causing a substantial uncertainty in outcomes per hospital. Although fourfold to eightfold differences between hospitals were noted, the uncertainty within hospitals caused a poor (<50%) rankability in three indicators and moderate rankability (50–75%) in the other four indicators.
Conclusion The currently used Dutch outcome indicators are not suitable for ranking hospitals. When judging hospital quality the influence of random variation must be accounted for to avoid overinterpretation of the numbers in the quest for more transparency in healthcare. Adequate sample size is a prerequisite in attempting reliable ranking.
Teamwok and team performance in multidisciplinary cancer teams: development and evaluation of an observational assessment tool
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Abstract
Aim Team performance is important in multidisciplinary teams (MDTs), but no tools exist for assessment. Our objective was to construct a robust tool for scientific assessment of MDT performance.
Materials and methods An observational tool was developed to assess performance in MDTs. Behaviours were scored on Likert scales, with objective anchors. Five MDT meetings (112 cases) were observed by a surgeon and a psychologist. The presentation of case history, radiological and pathological information, chair’s effectiveness, and contributions to decision-making of surgeons, oncologists, radiologists, pathologists and clinical nurse specialists (CNSs) are analysed via descriptive statistics, a comparison of average scores (Mann–Whitney U) to test interobserver agreement and intraclass correlation coefficients (ICCs) to further assess interobserver agreement and learning curves.
Results Contributions of surgeons, chair’s effectiveness, presentation of case history and radiological information were rated above average (p≤0.001). Contributions of histopathologists and CNS were rated below average (p≤0.001), and others average. The interobserver agreement was high (ICC=0.70+) for presentation of radiological information, and contribution of oncologists, radiologists, pathologists and CNSs; adequate for case history presentation (ICC=0.68) and contribution of surgeons (ICC=0.69); moderate for chairperson (ICC=0.52); and poor for pathological information (ICC=0.31). Average differences were found only for case-history presentation (p≤0.001). ICCs improved significantly in assessment of case history, and Oncologists, and ICCs were consistently high for CNS, Radiologists, and Histopathologists.
Conclusions Scientific observational metrics can be reliably used by medical and non-medical observers in cancer MDTs. Such robust assessment tools provide part of a toolkit for team evaluation and enhancement.
Hospital survey on patient safety culture: psychometric analysis on a Scottish sample
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Abstract
Objective To investigate the psychometric properties of the Hospital Survey on Patient Safety Culture on a Scottish NHS data set.
Methods The data were collected from 1969 clinical staff (estimated 22% response rate) from one acute hospital from each of seven Scottish Health boards. Using a split-half validation technique, the data were randomly split; an exploratory factor analysis was conducted on the calibration data set, and confirmatory factor analyses were conducted on the validation data set to investigate and check the original US model fit in a Scottish sample.
Results Following the split-half validation technique, exploratory factor analysis results showed a 10-factor optimal measurement model. The confirmatory factor analyses were then performed to compare the model fit of two competing models (10-factor alternative model vs 12-factor original model). An S–B scaled χ2 square difference test demonstrated that the original 12-factor model performed significantly better in a Scottish sample. Furthermore, reliability analyses of each component yielded satisfactory results. The mean scores on the climate dimensions in the Scottish sample were comparable with those found in other European countries.
Conclusions This study provided evidence that the original 12-factor structure of the Hospital Survey on Patient Safety Culture scale has been replicated in this Scottish sample. Therefore, no modifications are required to the original 12-factor model, which is suggested for use, since it would allow researchers the possibility of cross-national comparisons.
top teaching hospitals under threat from tariff system
Source: Exclusive: top teaching hospitals under threat from tariff system | News | Health Service Journal.
This article is solely the work of the HSJ. For a full copy of the article please contact the library.
The payment by results tariff system could tip England’s elite teaching hospitals into deficit and damage the country’s medical research industry, their chief executives have warned.
Alternatives to potentially inappropriate medications for use in e-prescribing software: triggers and treatment algorithms
This article is available freely via Open Access. Please click on the above link to view it fully.
Abstract
Objective To describe the development of evidence-based electronic prescribing (e-prescribing) triggers and treatment algorithms for potentially inappropriate medications (PIMs) for older adults.
Design Literature review, expert panel and focus group.
Setting Primary care with access to e-prescribing systems.
Participants Primary care physicians using e-prescribing systems receiving medication history.
Interventions Standardised treatment algorithms for clinicians attempting to prescribe PIMs for older patients.
Main outcome measure Development of 15 treatment algorithms suggesting alternative therapies.
Results Evidence-based treatment algorithms were well received by primary care physicians. Providing alternatives to PIMs would make it easier for physicians to change decisions at the point of prescribing.
Conclusion Prospectively identifying older persons receiving PIMs or with adherence issues and providing feasible interventions may prevent adverse drug events.
Health and social services expenditures: associations with health outcomes
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Abstract
Objective To examine variations in health service expenditures and social services expenditures across Organisation for Economic Co-operation and Development (OECD) countries and assess their association with five population-level health outcomes.
Design A pooled, cross-sectional analysis using data from the 2009 release of the OECD Health Data 2009 Statistics and Indicators and OECD Social Expenditure Database.
Setting OECD countries (n=30) from 1995 to 2005.
Main outcomes Life expectancy at birth, infant mortality, low birth weight, maternal mortality and potential years of life lost.
Results Health services expenditures adjusted for gross domestic product (GDP) per capita were significantly associated with better health outcomes in only two of five health indicators; social services expenditures adjusted for GDP were significantly associated with better health outcomes in three of five indicators. The ratio of social expenditures to health expenditures was significantly associated with better outcomes in infant mortality, life expectancy and increased potential life years lost, after adjusting for the level of health expenditures and GDP.
Conclusion Attention to broader domains of social policy may be helpful in accomplishing improvements in health envisioned by advocates of healthcare reform.
Systematic kidney disease management in a population with diabetes mellitus: turning the tide of kidney failure
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Abstract
Problem A significant proportion of patients with diabetes mellitus do not get the benefit of treatment that would reduce their risk of progressive kidney disease and reach a nephrologist once significant loss of kidney function has already occurred.
Design Systematic disease management of patients with diabetes and kidney disease.
Setting Diverse population (approximately 800 000) in and around Birmingham, West Midlands, UK.
Key measures for improvement Number of outpatient appointments, estimated glomerular filtration rate (eGFR) at first contact with nephrologist, number of patients starting kidney replacement therapy (KRT) and mode of KRT at start.
Strategy for change Identification of patients with low or deteriorating trend in eGFR from weekly database review, specialist diabetes–kidney clinic, self-management of blood pressure and transfer to multidisciplinary clinic >12 months before end-stage kidney disease.
Effects of change New patients increased from 62 in 2003 to 132 in 2010; follow-ups fell from 251 to 174. Median eGFR at first clinic visit increased from 28.8 ml/min/1.73 m2 (range 6.1–67.0) in 2000/2001 to 35.0 (11.1–147.5) in 2010 (p<0.006). In 2010, the number of patients starting KRT fell 30% below the projected activity using 1993–2003 data as baseline (p<0.003). The proportion starting KRT with either a kidney transplant, peritoneal dialysis or haemodialysis via an arteriovenous fistula increased from 26% in 2000 to 55% in 2010.
Lessons learned Systematic disease management across a large population significantly improves patient outcomes, increases the productivity of a specialist service and could reduce healthcare costs compared with the current model of care.
The ability of a behaviour-specific patient questionnaire to identify poorly performing doctors
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Abstract
Background Doctors’ ability to communicate with patients varies. Patient questionnaires are often used to assess doctors’ communication skills.
Objective To investigate whether the Four Habits Patient Questionnaire (4HPQ) can be used to assess the different skill levels of doctors.
Design A cross-sectional study of 497 hospital encounters with 71 doctors. Encounters were videotaped and patients completed three post-visit questionnaires.
Setting A 500-bed general teaching hospital in Norway.
Main outcome The proportion of video-observed between-doctor variance that could be predicted by 4HPQ.
Results There were strong correlations between all patient-reported outcomes (range 0.71–0.80 at the doctor level, p<0.01). 4HPQ correlated significantly with video-observed behaviour at the doctor level (Pearson’s r=0.42, p<0.01) and the encounter level (Pearson’s r=0.27, p<0.01). The proportion of between-doctor variance not detectable by 4HPQ was 88%. The reason for this discordance was large within-doctor between-encounter variance observed in the videos, and small between-patient variance in patient reports. The maximum positive predictive value for the identification of poorly performing doctors (92%) was achieved with a cut-off score for 4HPQ of 82% (ie, patient assessments were concordant with expert observers for these doctors).
Conclusion Using a patient-reported questionnaire of doctors’ communication skills, favourable assessments of doctors by patients were mostly discordant with the views of expert observers. Only very poor performance identified by patients was in agreement with the views of expert observers. The results suggest that patient reports alone may not be sufficient to identify all doctors whose communication skills need improvement training.
Cabinet Office review condemns NPfIT
Source: Cabinet Office review condemns NPfIT | News | Health Service Journal.
This article is solely the work of the HSJ. For a full copy of the article please contact the library.
Ministers have today pledged to hasten the demise of the National Programme for IT after a Cabinet Office review found that it could not deliver on its original aims
Cabinet Office review condemns NPfIT
Source: Cabinet Office review condemns NPfIT | News | Health Service Journal.
This article is solely the work of the HSJ. For a full copy of the article please contact the library.
Ministers have today pledged to hasten the demise of the National Programme for IT after a Cabinet Office review found that it could not deliver on its original aims
Leading doctor calls for more clinically-led reconfigurations
Source: Leading doctor calls for more clinically-led reconfigurations | News | Health Service Journal.
This article is solely the work of the HSJ. For a full copy of the article please contact the library.
Getting local clinicians to drive reconfiguration plans will reduce “overall system costs” and the number of letters sent to local MPs and newspapers, according to a hospital doctor leader
