We use a variety of operational research techniques such as optimisation, mathematical models and soft systems analysis to support health services in planning and service configuration decisions.
CORU staff involved: Christina Pagel, Sonya Crowe, Martin Utley, Luca Grieco, Zella King, Amalia Gjerloev
- WORKTECC (2017 - 2020)
WORKTECC: Workforce Operations that Realise Knowledge-based Transformational Efficiency gains in Community Care (2017 - 2020)
Serious financial pressures on the health and social care system and increasing elderly populations with complex needs make effective, sustainable services in the community crucial. NHS staff who provide home-based care spend a lot of time travelling, and the care provided by different professionals and provider organisations is often poorly coordinated. More efficient ways of delivering this care could reduce costs while also improving patient and staff experience.
CORU, in partnership with Care City, the Bayswater Institute and UCL Partners, are exploring whether workforce operations used by other industries can improve the efficiency of home-based NHS care, and if so, how. For example, online supermarkets use technology based on operational research algorithms to design efficient delivery routes that incorporate customer preferences on delivery times.
To do this, we will use structured stakeholder engagement and develop mathematical expressions to understand the commonalities, differences and trade-offs between different perspectives on efficiency in home-based care delivered by the NHS and how different facets of efficiency can be measured. We will then use analytical and rule-based heuristic modelling to identify operational strategies for improving efficiency, based on lone or combined workforce innovations available in the operational research literature. Importantly, we will establish the contextual requirements for these strategies to have their full effect. From this work in harness with parallel socio-technical systems analyses of current service delivery and the other statutory and community assets available at two sites in North East London, we will identify strategies that offer the best prospects of major efficiency gains.
This research is funded through the Health Foundation’s Efficiency Research programme and will be informed throughout by patient, carers, professionals, and the statutory and third sector organisations who will shape the future of these services.
- DEPICT study (2017 - 2020)
Paediatric intensive care transport services: DEPICT study (2017 - 2020)
CORU’s embedded work at Great Ormond Street Hospital directly contributed to a new NIHR funded national study, led by GOSH called DEPICT.Each year, 6000 children require emergency transfer from a local hospital to a PICU, on average 20-30 miles away. These children tend to be the sickest of PICU patients, and are more likely to die or have long lasting complications.
Transports of sick children to PICU are usually done by specialist retrieval teams (PICRTs). PICRTs are mobile intensive care teams, who take specialist expertise to the child and safely transport them to a PICU. Our previous research showed that PICRTs improve the survival of critically ill children. However, how quickly PICRTs are able to reach sick children, and how they are organised and deliver clinical care varies across the UK. We do not know if national variation in how PICRT services are organised and delivered matters, or whether current standards help achieve the best outcomes for patients.
In DEPICT, analysts will investigate what service delivery factors influence how likely a child is to survive and other clinical outcomes. Alongside this, we will also learn from interviews with families and staff what matters most to them about retrieval services. CORU will then take the insights from these quantitative and qualitative phases to build mathematical models to explore the impact of different service delivery configurations on children’s outcomes.
- NIHR Collaboration for Leadership in Applied Health Research and Care North Thames
NIHR Collaboration for Leadership in Applied Health Research and Care North Thames
The NIHR Collaboration for Leadership in Applied Health Research and Care North Thames is a major initiative to drive the conduct and uptake of research that makes a genuine difference to NHS services, professionals, patients and carers.
As well as providing leadership to the Methodological Innovation theme within the CLAHRC, CORU staff have:
- developed innovative visualisation of referrals into and between community care services and trained service leads in the use of these techniques;
- developed powerful methods drawing on fluid mechanics to approximate flows of patients within networks of services that display some of the complex dynamics seen in community care.
We are currently working with clinicians, managers and information teams at Great Ormond Street Hospital and University College London Hospital to develop simple mathematical models that could underpin software to give teams in different clinical environments useful predictions of forthcoming demand.
- Palmer, Fulop, Utley, "A systematic literature review of operational research methods for modelling patient flow and outcomes within community healthcare and other settings", Health Systems, https://doi.org/10.1057/s41306-017-0024-9, 2017
- Test Bed
CORU is leading the evaluation of the NHS England Innovation Test Bed at Care City, in collaboration with colleagues at UCL Department of Applied Health Research. The Test Bed is working to promote the adoption of innovative technologies and service pathways within the health and social care system in North East London, for instance introducing cheap and quick screening for atrial fibrillation to community pharmacies.
We are working to:
- conduct a qualitative analysis of different stakeholder perspectives on how the Care City team are working to promote adoption of innovation, and whether and how this could be better aligned with the priorities and aims of commissioners, providers and local authorities;
- identify from routine data sets any impact that the programme is having on measures such as diagnosis rates and health service utilisation;
- build and populate health economic models to understand the likely cost-effectivess of the innovations being promoted.
- Advanced data science to support health services (2018 onwards)
We are exploring several new areas where we can apply advanced data science techniques to support health services. Examples include:
- Using deep learning methods, time series analysis and other statistical models to use high-resolution data from bedside monitoring in children’s intensive care units to augment clinical decision making and prevent adverse events. This is a new collaboration between Great Ormond Street Hospital, CORU, The Turing Institute and Imperial College London, starting with a Turing Institute Data Study Group in April 2019.
- Using natural language processing to mine online health forums to analyse comments from patients to understand what patients are worried about. A better understanding of their concerns can feed in to research and healthcare priorities and practice, improving patient experiences and outcomes. This is a new collaboration between CORU, Imperial College London and the British Heart Foundation.
- Using a combination of operational research techniques (optimisation, network analysis), advanced statistical analysis and soft systems organisational research to address the threat of cyber attacks within healthcare. This is a new collaboration with Imperial College London.
- Using machine learning and network theory to help managers tackle overcrowding in the emergency department (ED) by predicting ED demand for beds and other resources (e.g. imaging) using routinely collected patient data. This is a collaboration with University College London Hospitals NHS Foundation Trust.
- BUBBLES (2020 - 2021)
- HYLODE (2021 - 2023)
- THIS (2021 - 2024)
- Helping US policy makers think through priorities for health care policy (2016-2019)
As part of her Harkness Fellowship in 2016/17, CORU Director Christina Pagel worked on a project to understand US policy maker health policy priorities during President Trump’s attempt to repeal and replace Obama’s flagship health reform (The Affordable Care Act, aka Obamacare). She designed and administered a survey to every US state politician serving on a health or appropriations committee asking them to rank their top health policy priorities. Nearly 400 people from across the US responded, almost exactly evenly split between Democrats and Republicans. Republicans said decreasing the role of government and reducing health care costs were among the most important issues for them. On the other hand, Democrats focused on increasing access, improving overall health, and reducing disparities. However, Democrats also rated reducing costs as a high priority, suggesting that tackling costs could be ripe for bipartisan policymaking. Follow on work by Dr David Jones at Boston University and the Milbank Memorial Fund showed however that Republican and Democratic state politicians had very different perceptions of what “reducing health care costs” actually meant.
Effective solutions to curtailing health care costs are unlikely until there is greater consensus on what “reducing costs” actually means. Without making transparent different perspectives of the nature of the problem, leaders will continue to talk past each other. In a new project, funded by the Milbank Memorial Fund, Christina Pagel and David Jones are working to explore further state policy makers’ priorities for reducing health care costs. This involves the design, administration and analysis of a new survey about health care costs followed by in depth interviews with legislators in some states to validate the survey results and to examine more comprehensively the potential points of consensus.
- Pagel, Bates, Goldmann, Koller, “A way forward for bipartisan health reform? Democrat and Republican state legislator priorities for the goals of health policy”, American Journal of Public Health, Aug 17:e1-e3. doi: 10.2105/AJPH.2017.304023, 2017
- Jones, Pagel, Koller, “The Future of Health Reform – A View from the States on Where We Go from Here”, NEJM, 379:2189-2191, 2018