ww.yhahsn.uk

1. Transforming Healthcare Rebecca LawtonProfessor, University of Leeds and Bradford Institute for Health Research ww.yhahsn.org.uk

2. What is transformation? • Fundamental or incremental change • Top down or bottom up • Driven by data, technology, new relationships… • Change in structures, processes, culture and behaviour

3. The AHSN role in transformation Data driven Top-down New relationships Incremental and Co-production Culture change fundamental change Bottom-up

4. The active ingredients of the AHSN • Positive practice network • Good improvement practice training • Peer-to-peer review • Patient engagement • Training and Action for Patient Safety • Behaviour change methods

5. What are the current challenges in Transforming Health Care? • How can research contribute to addressing these challenges? ww.yhahsn.org.uk

6. Driving Research Evidence into Practice ww.yhahsn.org.uk

7. How can research improve  qualityexamples from Maternal & Child Health John Wright on behalf of the researchers and clinicians in the Maternal and Child Health CLAHRC

8. CLAHRC maternal and child health • Develop communities of practice • Identify information needs • Establish accurate and reliable data collection • Link data to provide useful intelligence • Feedback timely and accurate data and evidence to practitioners • Promote professional change Bringing together researchers with practitioners from the NHS and Local Authorities to:

9. What difference does it make? • Improved detection of gestational diabetes: 2%-7% • Development of a regional congenital anomalies register • Increase in Vitamin D supplementation: 10-90% • Improvement in smoking cessation support • Changes to the red book! • Informing national policy for child health outcomes • Evidence based computerised prompts for GPs

10. How did we do it? • Align research and practice priorities • Communities of practice – time and space • Quality improvement techniques • Strong partnership between NHS and universities • Strong public engagement

11. CLAHRC goes to school

13. Driving Research Evidence into Practice ww.yhahsn.org.uk

14. Using evidence briefings to inform healthcare services Paul Wilson & Duncan Chambers Centre for Reviews and Dissemination University of York ww.yhahsn.org.uk

15. Renewed emphasis in NHS • Health and Social Care Act embeds research as a core function of the NHS • Assist conduct • Promote use • Unmanageable volume of research evidence • 20 million citations in PubMed • 75 RCTs published daily • 29,000 systematic reviews on DARE • 14,000 economic evaluations on NHS EED ww.yhahsn.org.uk

16. CRD knowledge translation service • Work with local decision makers (CLAHRC/ Non CLAHRC) to provide evidence informed answers to questions faced • Briefings based on existing synthesised evidence • Systematic reviews (DARE, Cochrane) • Economic evaluations (NHS EED) • Guidelines (NICE) • Highlight quality / strength of evidence, assess cost effectiveness, local applicability, implications relating to local service delivery, implementation and equity ww.yhahsn.org.uk

17. ww.yhahsn.org.uk

18. Outputs to date • 14 full briefings undertaken including: • Inpatient rehabilitationservices for the frail elderly • Non-pharmacological interventions for dementia • Tele-health • Drug treatments for patients with pulmonary hypertension • Integrated care pathways in mental health care settings • Nurse led endoscopy services • Alternatives to inpatient admission for adolescents with eating disorders • Feedback positive, but service developmental ww.yhahsn.org.uk

19. Future developments • Formal evaluation funded by HSDR commencing 2013 • AHSN offers an opportunity to upscale service from local to regional • AHSN Translating Research & Learning into Practice • Commitment to provide a bespoke evidence synthesis service to support service planning and delivery • Contribute to delivery of Health and Social Care Act obligations ww.yhahsn.org.uk

20. Driving Research Evidence into Practice ww.yhahsn.org.uk

21. information absent from implementation/transformation decision making: Part I - economics Carl Thompson Professor TRiP-LaB, University of York

22. when the costs of “changing behaviour” are included in the implementation of even “cost effective” technologies… Sometimes… It just isn’t “worth it” “Ensuring this large scale adoption takes place is the task of every person working within the NHS and those accessing its services - we must all contribute$.” $www.institute.nhs.uk/innovation/innovation/introduction.html

23. £…..£££….??? Audit and feedback Educational outreach Literature/leaflets/passive dissemination Educational events Academic detailing Reminder systems IT templates and decision “support”…

24. [policy] cost effectiveness cf.Mason et al, JAMA 2001

25. 9000 2500 – 11000 “missing”

26. Example: “Opportunistic Case Finding” for COPD • Evidence: • Four person QI team 0.5 wte for 6 months ≈ £50000 • additional patients treated? • 50 £23533/QALY • 100 £12170/QALY

28. For the AHSN

29. What are the current challenges in Transforming Health Care? • How can research contribute to addressing these challenges? ww.yhahsn.org.uk