Research

Key contacts: Dr Helen Barratt, Miss Sarah Jasim

Chief Investigator: Dr Helen Barratt

Co-investigators: Dr Simon Turner, Mr Andrew Hutchings, Dr Elena Pizzo, Ms Emma Hudson, Professor Steve Morris, Professor Naomi Fulop, Professor Rosalind Raine, Dr Jean Ledger, Dr Sarah Jasim

Orthopaedic procedures, such as total hip replacement and total knee replacement, are among the commonest surgical procedures in England. Funded by the Department of Health, the Getting it Right First Time project (GIRFT) aims to deliver improvements in quality and reductions in the cost of NHS orthopaedic care across the country. Researchers from NIHR CLAHRC North Thames will examine whether the planned changes have delivered improvements in quality of care and patient outcomes. We will also study the processes involved in developing and implementing changes to care, and the professional and organisational factors influencing these processes. In doing so, we will identify lessons to guide future improvement work in other services.

1. Qualitative methods will be used to understand the GIRFT approach and study the effect of the intervention on practice at both national and provider level, using a case study approach.

2. Quantitative and economic analysis methods will be used to examine 'what works and at what cost?' 

3. We will also conduct focus groups with patients and members of the public to explore their perceptions of the GIRFT programme. 

We will identify generalisable lessons to inform the organisation and delivery of future improvement programmes, to optimise their implementation and impact, both within the UK and internationally. 

Using patient information

One aspect of this study uses statistical methods, including economic analysis, to examine 'what works and at what cost?'

We are trying to assess whether the GIRFT programme has reduced variations in orthopaedic practice and costs, and improved patient outcomes. To do this, we are requesting confidential patient data for a group of patients who have undergone elective orthopaedic surgery between 1^st April 2009 and 31^st March 2018.

The data we would like to use include Hospital Episode Statistics (HES), a database containing details of all admissions to NHS hospitals in England, which is collected so that hospitals can be paid for the care they deliver. These data can also be processed and used for other purposes, such as research and planning health services. We would also like to use data from the National Joint Registry, which records details of joint replacement operations in order to monitor the results of surgery and protect patient safety.

Secure storage and processing of patient information

Researchers will not be able to identify patients, using the information that they are given by the organisations (National Joint Registry and NHS Digital). Personal identifiers of patients will only be securely transferred between these two organisations, so NHS Digital can link them together, to provide more accurate and complete information for researchers.

Both organisations will securely transfer pseudonymised data to researchers at UCL, so patient information can be processed without researchers being able to identify patients.

All pseudonymised patient information will be stored on a secure network that is password-protected, and can only be accessed by those with specialised training and access for the duration of the study.

Opting-out

If you would like further information about the use of your data in this research study, or would like to request that your confidential patient information is not included in this study, please contact us between 1^st May - 1^st June 2018 to discuss.

Contact details:

Dr Sarah Jasim

NIHR CLAHRC North Thames

Department of Applied Health Research

University College London

1-19 Torrington Place

London WC1E 7HB

Tel: 020 3105 3233

E-mail: clahrc.girft-evaluation@ucl.ac.uk

How will this be operated?

To ensure feasible and practical methods of opt-out, we will offer patients a 1-month window to be able to contact us. For those patients who require further information about how their confidential patient information will be used, we will provide this via e-mail or arrange telephone conversations to provide further information and reassurance. For those patients who would like their data to be removed from the cohort included in our research - we will ask for the minimum variables necessary to first correctly identify patients, and then to enable NHS Digital to remove these specific patients for the linkable NJR and HES-PROMs dataset they are preparing for us. We will then provide these variables securely in one spreadsheet to NHS Digital, so they can remove these patient records from the dataset they will send us. The spreadsheet containing this patient information will be deleted as soon as this process is complete. As patients are providing us with this sensitive information for the purposes of the opt-out mechanism, we will also explain that this will be shared with NHS Digital for them to be able to remove their records from the dataset.

Key contacts: Dr Angus Ramsay and Chloe Levelle

Chief Investigator: Professor Naomi Fulop

Co-investigators: Professor Steve Morris, Professor Kathy Pritchard-Jones, Professor Ruth Boaden, Dr Angus Ramsay, Ms Rachael Hunter, Mr John Hines and Mr David Shackley.

Remembering our colleague Neil Cameron:

Sadly one of our PPI  colleagues Mr Neil Cameron died on 15^th May 2017. Neil contributed a great deal to the study, from the development of the proposal, in particular providing essential feedback on our research questions in relation to patient experience, through to the work of the study to date. We will continue to acknowledge Neil's contribution to our study in any outputs that we make.

Researchers:

We have a number of researchers working on RESPECT 21.

Qualitative Researchers:

Dr Cecilia Vindrola, University College London

Dr Victoria Wood, University College London

Dr Catherine Perry, University of Manchester

Dr Sarah Darley, University of Manchester

Quantitative and Health Economics Researchers:

Dr Caroline Clarke, University College London

Dr Maria Melnychuk, University College London

Study Overview

A research team led by Professor Naomi Fulop (UCL Department of Applied Health Research) has been awarded £1.2 million over three and a half years by the National Institute for Health Research Health Services and Delivery Research Programme to study the centralisation of specialist cancer surgical services.

The study, which started in September 2015, will focus on the impact of the centralisation of specialist surgical pathways for four cancers across two health care systems: London Cancer (a network of providers across North Central and North East London, and West Essex; population 3.2m) and Manchester Cancer (covering Greater Manchester and East Cheshire; population 3.1m). The research team is formed of clinicians, patients, and academics from London (UCL and London Cancer) and Manchester (University of Manchester and Manchester Cancer).

The research will combine quantitative and qualitative methods to analyse how the centralisations were planned and implemented, and the impact of the changes on organisation and delivery of care, clinical outcomes, patient experience, and cost-effectiveness. The study will also analyse patient, professional, and public preferences for changes of this kind. In doing so, it will address a number of important gaps in the evidence on centralising specialist cancer surgery, addressing key priorities highlighted in the Five Year Forward View. In addition, it will build on methods developed by the team in conducting high impact research on other forms of major system change.

Further information

• NIHR HS&DR project work
• Wise.J. Research team to look at the effect of major reorganisation of cancer surgery. BMJ.2015.351

Publications

Fulop.N et al. Reorganising specialist cancer surgery for the twenty-first century: a mixed mehtords evaluations (RESPECT-21): Implementations Science 2016 11: 155 (Study Protocol)

Melnychuk et al. Centralising specialist cancer surgery services in England: survey of factors that matter to patients and carers and health professionals. BMC Cancer 2018;18:226.

Vallejo-Torres et al. Discrete-choice experiment to analyse preferences for centralizing specialist cancer surgery services. Br J Surg 2018 10.1002/bjs.10761.

NIHR CLAHRC North Thames

CLAHRC Director: Professor Rosalind Raine
Deputy CLAHRC Director: Professor Mike Roberts
CLAHRC North Thames Academy Director: Dr Nora Pashayan
Deputy Lead CLAHRC North Thames Academy: Dr Helen Barratt

National Institute of Health Research (NIHR) Collaborations for Leadership in Applied Health Research and Care (CLAHRCs) conduct world class applied health research which will have a direct impact on the health of patients with long term conditions and on the health of the public.

CLAHRCs are collaborations between universities, the NHS (local service providers and commissioners), local authorities, industry, patients and the public, the local Academic Health Science Network (AHSN) and other relevant organisations in the region. By working together, CLAHRCs can deliver nationally relevant research that responds directly to the needs and priorities of their region, and increase the speed at which research evidence is put into practice, locally and nationally.

NIHR awarded funding to 13 CLAHRCs across England in January 2014 for five years.

NIHR CLAHRC North Thames is led by our Director, Prof Rosalind Raine (who is Head of the Department of Applied Health Research at UCL). Hosted by Barts Health NHS Trust, it covers the geographical area of north central and north east London, south and west Hertfordshire, south Bedfordshire and south west and mid-Essex.

The applied health research we undertake with our partners and in response to their needs is grouped into five broad themes:
„„- Child and adolescent health
„„- Empowering mental health service users and families
„„- Innovations in systems and models of health and health care
„„- Methodological innovation
„„- Optimising behaviour and engagement with care

Individual projects in these areas are designed with the close involvement of clinicians, patients and the public, and academics from across our region. In addition to conducting ground breaking research, the CLAHRC has an important role in training the next generation of healthcare workers and applied health researchers, via the CLAHRC Academy. Find out more about our capacity building and training programmes in the Academy section.

For further information please visit the CLAHRC website.