Driving progress in healthcare through NHS research
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Transcript of Driving progress in healthcare through NHS research
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Driving progress in health care through NHS researchNational Institute for Health Research
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IntroductionWilliam van’t Hoff, Clinical Director for NHS Engagement, NIHR Clinical Research Network
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• Provide a flavour of the many different ways in which the NIHR is driving progress in healthcare
• Share our experiences of the NIHR, but also provide a wider national view
• This will be followed by a Q&A panel session
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Come talk to us about how the NIHR can help your NHS improve through research – stand 119
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The benefits and impact of clinical academics and NIHR traineesGilly Howard-Jones, Lymphoma Clinical Nurse Specialist,University of Southampton NHS Foundation Trust and NIHR Clinical Doctoral Research Fellow
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Overview
• My background
• My research
• Clinical development during the fellowship
• Outcomes so far
• Looking to the future
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My background
• RGN Diploma 1993• Cancer nursing • BSc. Nursing 1996• MSc. Medical Anthropology 2000• NIHR MRes 2012, NIHR Internship 2013• NIHR Clinical Academic Fellowship 2014
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My Research : The influence of social networks on self-management support in cancer survivors: A mixed methods StudyQuantitative postal survey
Qualitative interviewsInvited to
participate from survey
Interpretation based on Quantitative (qualitative )
results
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Undertaking clinical development• Planning the application with clinical staff
- Member of NICE Guidance Development Group for NHL - Patient Triggered Follow Up - Advanced Nurse Practitioner role development
• Engagement with Lymphoma Association - Supporting development of survivorship services
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Outcomes so far…..
• Patient experience
• Team
• Hospital Trust
• University
• National influence
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Looking to the future
•Completing my PhD !
•Creating a new clinical academic post
•Clinical Lectureship application- TIME and
RESOURCES
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How DRAFFT improved care, made cost savings and achieved consistency across the NHSMike Reed, Consultant Trauma and Orthopaedic Surgeon,Northumbria Healthcare NHS Foundation Trust
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About Me
Trauma and orthopaedic surgeonFull time clinicianI just do regular trauma on callI’ve run some clinical trialsNo involvement in this study (although I did do some surgery)“So why are you here?”
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Background
In the Western World, 6% of women will have sustained a fracture of the distal radius by the age of 80 and 9% by the age of 90
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Most common interventions in the UK
• Wires• Volar fixed-angle plates
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Most common interventions in the UK....
VS
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Funding• National Institute for Health Research
Health Technology Assessment
• Why?
• Clinical and cost-effectiveness
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DRAFFT Centres
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Outcome MeasuresPrimary • Patient Reported Wrist Evaluation (PRWE)Secondary• Disability of the Arm, Shoulder and Hand (DASH)• Radiographic changes• Complications• Health Economics (EQ-5D, resource use)
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RecruitmentA
ug-1
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Apr
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Jul-1
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0
50
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150
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350
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500Overall Pro-jectionActual
Patie
nts
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Numbers
• Screened: 12,000 patients with a distal radius fracture• Eligible: 639 patients• Recruited: 461patients (more than anticipated)• Follow-up: over 90% at each time-point
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Patient-rated wrist evaluation
Lower score = better outcome
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The result
This large, multi-centre, pragmatic clinical trial shows that there is no difference in patient-reported wrist evaluation in the twelve months following Wire fixation versus locking-plate fixation.
Confidence intervals exclude a clinically relevant effect (95% CI; -4.5 to 1.7)
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The result: sub-groups
No difference in under 50 years versus over 50 years
No difference in those with intra-articular extension versus extra-articular
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Result: further surgery• 5 patients in the wire group and 2 in the plate group
required revision surgery for loss of reduction
• 9 patients in the plate group required removal of symptomatic metalwork (4 for screw penetration of the joint) and 1 patient with a buried K-wire required removal in theatre
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The result: Health EconomicsEconomic evaluation completely driven by the choice of implantWires were cheaper: £54 vs £854No difference in Quality of Life in the 12 months after surgery
Therefore, wires are cost saving
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So what happened next?
• Did anyone take any notice?• Did anyone get upset?
• And, did anyone change their practice?
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National/international presentations:
• Trauma Trials Meeting• OTS• BSSH• BOA• EFORT• OTA• NZOA
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Local presentations/meetings
• Many site visits• Local presentations by the Principal Investigators• Teaching courses
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Papers
• British Medical Journal• NIHR-HTA Monograph• Bone and Joint Journal• Patient newsletters
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Modern stuff…
• Podcasts• Journal Blogs• ‘Tweeting’…
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So did anyone get upset about DRAFFT?
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Yes
…mostly the hand surgeons…!
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Reaction…
• “…in my hands…”
• “I’m not a statistician, but I have concerns about the statistics”
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So people heard the results, but did they take any notice?
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English HospitalEpisode Statistics:surgery for fractureof the distal radius
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Cool!
• But surely not everyone changed their practice…
• Surely not the hand surgeons…
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Time 0 Pre trial Pre results Post results0
10
20
30
40
50
60
70
80
90
hand units plate
hand units wire
non-hand units plate
non-hand units wire
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So everyone is changing?
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NORTHUMBRIA
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Conclusions• Use more wires. Save lots of money.
• UK Orthopaedic Trauma Surgeons can deliver multi-centre clinical trials
• They really do change clinical practice!
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How the money stacks up…
DRAFFT cost the taxpayer about £1.5 million
The 25% shift in practice has already saved £1.6 millionWill continue to save year on year.
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NIHR Musculoskeletal Trauma TrialsPROFHER
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RESULTS NEXT WEEK
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Patient experience of participating in researchVee Mapunde, Associate Consumer LeadNational Cancer Research Institute
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The NCRI Consumer Forum – BackgroundFormed in April 2015, funded by NCRI (with NIHR support), follows CLG (funded by NIHR Clinical Research Cancer Specialty Group)
Objective:To create a professional, focussed and committed constituency of consumer research partners, who can help NCRI achieve its aims
Nine specific points, including: To provide a pool of well-trained consumers to input into NCRI and partner research activities, committees and groups, as equal and valued partners
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How I got involvedDiabetes• Why him? And why now?• Could I have stopped this?
Prostate Cancer• Why is it that some people can “live” with this condition?• Why is it more aggressive in some ethnic groups?• How does this affect patient outcomes?• What impact can I make?
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How patient involvement benefits the NHS• Patient experiences can drive service improvements and promote research• Patients get involved in finding solutions when researchers bring ideas or problems to
them • Taking part in research is associated with better experience of care – 88% of all
cancer patients are satisfied/v satisfied with care; increases to 93% for participants• Increase our understanding of challenges associated with hard-to-reach groups,
geographical inequalities of access to research opportunities, gaps in clinical trial portfolios, matching patient priorities
• We can change practice faster – working with the NIHR, NICE and MRC CTU
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Q&A panel session
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Remember, we’re on stand 119 if you would like to find out more
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Thank you all for attending and taking part